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Life course structural equation model of the effects of prenatal and postnatal growth on adult blood pressure
  1. Marika Kaakinen1,2,3,
  2. Ulla Sovio4,
  3. Anna-Liisa Hartikainen5,6,
  4. Anneli Pouta5,6,7,
  5. Markku J Savolainen2,6,8,
  6. Karl-Heinz Herzig2,6,9,
  7. Paul Elliott3,
  8. Bianca De Stavola10,
  9. Esa Läärä11,
  10. Marjo-Riitta Järvelin1,2,3,7,12
  1. 1Institute of Health Sciences, University of Oulu, Oulu, Finland
  2. 2Biocenter Oulu, Oulu, Finland
  3. 3Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
  4. 4Department of Obstetrics & Gynaecology, University of Cambridge, Cambridge, UK
  5. 5Institute of Clinical Medicine/Obstetrics and Gynaecology, University of Oulu, Oulu, Finland
  6. 6Medical Research Center, Oulu University Hospital, Oulu, Finland
  7. 7Department of Children and Young People and Families, National Institute for Health and Welfare, Oulu, Finland
  8. 8Institute of Clinical Medicine/Internal Medicine, University of Oulu, Oulu, Finland
  9. 9Institute of Biomedicine/Physiology, University of Oulu, Oulu, Finland
  10. 10Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
  11. 11Department of Mathematical Sciences, University of Oulu, Oulu, Finland
  12. 12Unit of Primary Care, Oulu University Hospital, Oulu, Finland
  1. Correspondence to Dr Marika Kaakinen, Department of Genomics of Common Disease, School of Public Health, Imperial College London, Hammersmith Hospital, Burlington Danes Building, DuCane Road, London, W12 0NN, UK m.a.kaakinen{at}


Background Fetal and postnatal growth have been associated with adult blood pressure (BP), but findings about the relative importance of growth at different stages of life on BP are inconsistent.

Methods The study population comprised 5198 participants from the Northern Finland Birth Cohort 1966 with data on birth weight, height and weight measurements until adolescence, systolic and diastolic BP at 31 years and several covariates. Structural equation modelling was used in the analysis.

Results Negative direct effects of birth weight on adult systolic BP were observed (standardised regression coefficients: −0.08 (−0.14 to −0.03) in males and −0.04 (−0.09 to 0.01) in females, equalling −1.99 (−3.32 to −0.65) and −1.01 (−2.33 to 0.32) mm Hg/kg, respectively). Immediate postnatal growth was associated with adult BP only indirectly via growth later in life. In contrast, growth from adiposity rebound onwards had large direct, indirect and total effects on adult BP. Current body mass index was the strongest growth-related predictor of adult BP (0.36 (0.30 to 0.41) in males and 0.31 (0.24, 0.37) in females, equalling 1.29 (1.09 to 1.48) and 0.81 (0.63 to 0.99) mm Hg/(kg/m2), respectively).

Conclusions Our path analytical approach provides evidence for the importance of both fetal growth and postnatal growth, especially from adiposity rebound onwards, in determining adult BP, together with genetic predisposition and behavioural factors.

  • Epidemiological methods
  • Life course epidemiology

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