Optimal maternal nutrition during pregnancy decides the nutrition status of the fetus and neonate. The intrauterine growth of the fetus is affected by multiple factors, including maternal nutrition, intrinsic fetal factors, and uteroplacental function. When these are inadequate, fetal growth becomes restricted, resulting in malnutrition. The diagnosis of fetal malnutrition is made based on clinical features like loose skin folds and flat cheeks due to a lack of subcutaneous fat and deranged values of anthropometric proportionality indices. Fetal malnutrition has short-term effects like metabolic and electrolyte imbalances during the neonatal period and long-term problems affecting adulthood. The adaptive and epigenetic changes in the fetal tissues increase the risk and incidence of coronary death, type 2 diabetes, and metabolic syndrome during adulthood. The global burden of fetal malnutrition is significant. Since this condition is directly related to maternal nutrition and socioeconomic status, public health policies and interventions should focus on improving the nutrition of expectant mothers and women in their reproductive age group. This chapter focuses on the burden of fetal malnutrition and etiopathogenesis of fetal programming and includes nutritional recommendations for pregnant women to prevent fetal malnutrition.