BACKGROUND: Birth-size is a problematic proxy for the fetal environment, and regression models testing for associations between birth-size and blood pressure have been criticized. METHODS: We modelled fetal environment as a latent variable determined by maternal height and arm fat area (AFA) during pregnancy using structural equation modelling. We tested for associations between latent fetal environment (LFE) and systolic blood pressure (SBP) while controlling for birth weight (BW) and current weight (CW). Data are from 1435 male and 1218 female young adult Filipinos (2005; mean age 21 years) enrolled in the Cebu Longitudinal Heath and Nutrition Survey, an ongoing, community-based study of a one-year birth cohort. Using AMOS 6.0, LFE was modelled as a determinant of BW, CW and SBP; CW was modelled as a determinant of SBP. RESULTS: Overall model fit was excellent (chi2: 32.14, 27 df, P=0.23). The estimated direct relationship between LFE and SBP was inverse for both males ((-0.43) -0.26 (-0.10)) and females ((-0.29) -0.18 (-0.07)). CONCLUSIONS: These results are consistent with the hypothesis that maternal height and AFA impact fetal development in a manner that is positively associated with fetal growth (as reflected by BW) and inversely associated with SBP in young adulthood.