Maternal access to food during pregnancy affects birth weight and other characteristics of offspring. It has been suggested that fluctuations in food availability during infancy, ranging from plentiful to starvation, may influence cerebro-cardiovascular risk factors for the offspring during adult life. This study was designed to test the correlation between food availability changes during life before birth and adult sudden death from disease. This was a follow-up study of ancient cohorts in the parish of Skellefteå, Sweden, comprising 7,572 individuals born between 1805 and 1849 and still alive at age 40. Food availability variations in the parish during their prenatal life were ascertained from historical sources, the main outcome measures being overall mortality and mortality from sudden death in the age range 40-70 years. The risk of sudden death was almost doubled for those whose mothers were struck by a poor harvest during the early stages of pregnancy, but who experienced a good harvest toward the end. Yet almost the same over-risk was evident for the converse case: plentiful food supply in early pregnancy followed by a poor harvest toward the end. A stable maternal access to food during pregnancy is important for the offspring's risk of sudden death from cerebro- and cardiovascular disease as an adult. Am. J. Hum. Biol. 12:447-453, 2000. Copyright 2000 Wiley-Liss, Inc.