Current knowledge on associations between variations in fetal growth on the one hand and blood pressure, noninsulin dependent diabetes, coronary heart disease and cancer in adulthood on the other is reviewed and related to more conventional preoccupations of perinatal epidemiology. Commonly used definitions and indicators of impaired fetal growth, possible explanations and mechanisms of the association between fetal growth impairment and later disease, and the concept and operational definitions of programming are discussed. Implications and research priorities that can be derived from this information are presented.