The origins of cardiovascular disease are related to genetic factors, postnatal environmental and behavioral influences, and also the environment experienced in utero. Patterns of disproportionate fetal growth consistent with maternal undernutrition appear to be predictive of later hypertension and coronary heart disease. These findings from epidemiologic studies are strongly supported by animal studies. Experimental models are suggestive of a role for glucocorticoid hormones in the intrauterine programming of cardiovascular function. New understanding of the relationships between maternal diet and the development and maturation of fetal tissues may enable prevention of cardiovascular disease by intervention in early life.