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Epidemiology and Population Health

Maternal and infant prediction of the child BMI trajectories; studies across two generations of Northern Finland birth cohorts



Children BMI is a longitudinal phenotype, developing through interplays between genetic and environmental factors. Whilst childhood obesity is escalating, we require a better understanding of its early origins and variation across generations to prevent it.


We designed a cross-cohort study including 12,040 Finnish children from the Northern Finland Birth Cohorts 1966 and 1986 (NFBC1966 and NFBC1986) born before or at the start of the obesity epidemic. We used group-based trajectory modelling to identify BMI trajectories from 2 to 20 years. We subsequently tested their associations with early determinants (mother and child) and the possible difference between generations, adjusted for relevant biological and socioeconomic confounders.


We identified four BMI trajectories, ‘stable-low’ (34.8%), ‘normal’ (44.0%), ‘stable-high’ (17.5%) and ‘early-increase’ (3.7%). The ‘early-increase’ trajectory represented the highest risk for obesity. We analysed a dose-response association of maternal pre-pregnancy BMI and smoking with BMI trajectories. The directions of effect were consistent across generations and the effect sizes tended to increase from earlier generation to later. Respectively for NFBC1966 and NFBC1986, the adjusted risk ratios of being in the early-increase group were 1.08 (1.06–1.10) and 1.12 (1.09–1.15) per unit of pre-pregnancy BMI and 1.44 (1.05–1.96) and 1.48 (1.17–1.87) in offspring of smoking mothers compared to non-smokers. We observed similar relations with infant factors including birthweight for gestational age and peak weight velocity. In contrast, the age at adiposity peak in infancy was associated with the BMI trajectories in NFBC1966 but did not replicate in NFBC1986.


Exposures to adverse maternal predictors were associated with a higher risk obesity trajectory and were consistent across generations. However, we found a discordant association for the timing of adiposity peak over a 20-year period. This suggests the role of residual environmental factors, such as nutrition, and warrants additional research to understand the underlying gene–environment interplay.

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Fig. 1: BMI z-scores trajectories of NFBC studies from 2 to 20 years.
Fig. 2: Forest plot of unadjusted and adjusted risk ratios (RR) between maternal parameters and BMI z-scores trajectory classes.
Fig. 3: Forest plot of unadjusted and adjusted risk ratios (RR) between early growth parameters and BMI z-scores trajectory classes.

Data availability

Data are available from the Northern Finland Birth Cohort (NFBC) for researchers who meet the criteria for accessing confidential data. Please, contact NFBC project centre ( and visit the cohort website ( for more information.


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We thank all cohort members and researchers who participated in the Northern Finland Birth Cohorts 1966 and 1986. We also wish to acknowledge the work of the NFBC project centre.


This work was supported by European Union’s Horizon 2020 research and innovation programme [DYNAHEALTH 633595, LIFECYCLE 733206, EUCANCONNECT 824989, LongITools 874739, EarlyCause 848458], Academy of Finland [EGEA 285547] and the JPI-HDHL programme [PREcise—MRC-UK P75416]. The funding sources had no influence in the study design, collection, analysis, interpretation of data, writing of the report and in the decision to submit the article.

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Correspondence to Marjo-Riitta Järvelin.

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Ethical approval

All procedures performed were in accordance with the 1964 Helsinki declaration. The Ethics Committee of the Northern Ostrobothnia Hospital District has approved the NFBC1966 and NFBC1986 studies.

Informed consent

Mothers gave their informed consent in the beginning of the NFBC1966 and 1986 data collections. Written informed consent has been obtained from the cohort participants in the 31- and 46-year data collections.

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Nedelec, R., Miettunen, J., Männikkö, M. et al. Maternal and infant prediction of the child BMI trajectories; studies across two generations of Northern Finland birth cohorts. Int J Obes 45, 404–414 (2021).

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