Key points• This study investigates the impact that insulin-like growth factor 2 receptor (IGF-2R) activation has on the fetal heart, by infusing Leu 27 IGF-2 into the left circumflex coronary artery of the sheep fetus, to specifically activate IGF-2R and it's downstream signalling pathway.• Activation of cardiac IGF-2R resulted in cardiomyocyte hypertrophy, but with no changes in heart weight, cardiomyocyte proliferation, binucleation or apoptosis. This hypertrophy was mediated via protein kinase A activation.• Infusion of Leu 27 IGF-2 increases atrial natriuretic peptide abundance, a marker of cardiac pathological hypertrophy.• Cardiac IGF-2R activation may alter important regulators of cardiac contractility and relaxation by decreasing sarcoplasmic reticulum Ca 2+ -ATPase and phospho-troponin I abundance.• This study places the interaction between the IGF-2R and Gαs signalling pathway as a potential mechanism that can contribute to cardiomyocyte growth in fetal life, but which may result in pathological cardiac hypertrophy in postnatal life.Abstract In vitro studies using rat and fetal sheep cardiomyocytes indicate that, in addition to its role as a clearance receptor, the insulin-like growth factor 2 receptor (IGF-2R) can induce cardiomyocyte hypertrophy. In the present study, we have determined the effect of specific activation of the IGF-2R in the heart of the late gestation fetus on cardiomyocyte development. Leu 27 IGF-2, an IGF-2R agonist, was infused into the fetal left circumflex coronary artery for 4 days beginning at 128.1 ± 0.4 days gestation. Ewes were humanely killed at 132.2 ± 1.2 days gestation (term, 150 days). Fetuses were delivered and hearts dissected to isolate the cardiomyocytes and to collect and snap-freeze tissue. Leu 27 IGF-2 infusion into the left circumflex coronary artery of fetal sheep increased the area of binucleated cardiomyocytes in the left, but not the right, ventricle. However, this infusion of Leu 27 IGF-2 did not change fetal weight, heart weight, blood pressure, blood gases or cardiomyocyte proliferation/binucleation. The increase in cardiomyocyte size in the Leu 27 IGF-2-infused group was associated with increased expression of proteins in the Gαs, but not the Gαq, signalling pathway. We concluded that infusion of Leu 27 IGF-2 into the left circumflex coronary artery causes cardiac IGF-2R activation in the left ventricle of the heart, and this stimulates cardiomyocyte hypertrophy in a Gαs-dependent manner.