An ever increasing body of evidence indicates that cardiovascular disease is determined by prenatal experience of undernutrition. Animal experiments suggest that in addition to maternal dietary interventions, exposure of the fetus to glucocorticoid hormones may programme fetal physiology and metabolism, such that cardiovascular functions are permanently altered. Through nutritional regulation of maternal-placental-fetal hormone interactions long term risk of hypertension may be established long before exposure to adult lifestyle factors more usually associated with cardiovascular mortality.