Introduction: Evidence is mounting to suggest that maternal nutritional factors during pregnancy will have both short- and long-term consequences to the health of the child. Recent studies show a direct connection between gestational environment (nutrition, chemical exposure, stress, and exercise) and elevated risk of chronic disease in the adult offspring, many decades later. These studies strongly emphasize the importance of proper prenatal care and nutrition as they relate to both improved neonatal outcome, and long-term adult health of the child. Objective: The objective of this article is to provide a comprehensive review of the relationship between prenatal nutritional choices and relative risk of chronic disease in adult offspring. Methods: A systematic search of the literature was performed and reviewed, that focused on gestational nutritional aspects that are thought to substantially relate to birth outcome and risk of adult-onset chronic central nervous, cardiovascular, reproductive, musculoskeletal, immune, metabolic, and neoplastic diseases in offspring. Three databases were searched and relevant original works, retrospective and prospective studies, and review articles from all available years were selected; studies involving human subjects and animal models of human disease were included, whereas veterinary studies were excluded. Databases searched included Pub Med, Biological Abstracts from Ovid, and CAB Abstracts. The major MeSH search terms for Pub Med were “embryonic and fetal development”, with “physiology, immunology, and genetics” as subheadings, AND “prenatal nutrition” with same subheadings; this search yielded 27 results. Search terms constructed in Biological Abstracts included “fetal programming AND nutrition”, and yielded 559 results. Results of search using “fetal programming” search term in CAB Abstracts from CAB Direct yielded 132 results. Results and Discussion: The theory of the “developmental origins of health and disease” was coined by David Barker, and suggests that maternal environment can alter fetal programming during times of genetic plasticity, and modify the trajectory of development into adulthood. This theory hypothesizes that the fetus adapts to a suboptimal gestational environment by choosing pathways of gene expression and cell differentiation resulting in adoption of a structure, physiologic state, or behavior that best suits the current situation. This results in manifestation of an alternate thrifty phenotype in anticipation of possible future suboptimal postnatal environments. However, if the postnatal environment does not accurately reflect what was anticipated by the fetus prenatally, the epigenetic changes adopted by the child before birth may inadequately prepare him or her for healthy postnatal life. The phenotypic changes that result from adverse maternal caloric, protein, carbohydrate, fat, or micronutrient intake, are thought to not be repaired postnatally, and unwittingly predispose the adult offspring to a higher incidence of cognitive dysfunction, obesity, hypertension, diabetes mellitus, immune dysfunction, infertility, cardiovascular disease, osteoporosis, and cancer. Putative mechanisms and current theories are discussed in this review.