In many species, the pattern of growth and physiological development in utero has an important role in determining not only neonatal viability but also adult phenotype and disease susceptibility. Changes in fetal development induced by a range of environmental factors including maternal nutrition, disease, placental insufficiency and social stresses have all been shown to induce adult cardiovascular and metabolic dysfunction that often lead to ill health in later life. Compared to other precocious animals, much less is known about the physiological development of the fetal horse or the longer-term impacts on its phenotype of altered development in early life because of its inaccessibility in utero, large size and long lifespan. This review summaries the available data on the normal metabolic, cardiovascular and endocrine development of the fetal horse during the second half of gestation. It also examines the responsiveness of these physiological systems to stresses such as hypoglycaemia and hypotension during late gestation. Particular emphasis is placed on the role of the equine placenta and fetal endocrine glands in mediating the changes in fetal development seen towards term and in response to nutritional and other environmental cues. The final part of the review presents the evidence that the early life environment of the horse can alter its subsequent metabolic, cardiovascular and endocrine phenotype as well as its postnatal growth and bone development. It also highlights the immediate neonatal environment as a key window of susceptibility for programming of equine phenotype. Although further studies are needed to identify the cellular and molecular mechanisms involved, developmental programming of physiological phenotype is likely to have important implications for the health and potential athletic performance of horses, particularly if born with abnormal bodyweight, premature or dysmature characteristics or produced by assisted reproductive technologies, indicative of an altered early life environment.