Pubarche as well as thelarche may be a marker for the onset of puberty

Childhood adversity and accelerated reproductive events: a systematic review and meta-analysis

OBJECTIVE

Accelerated female reproductive events represent the early onset of reproductive events involving puberty, menarche, pregnancy loss, first sexual intercourse, first birth, parity, and menopause. This study aimed to explore the association between childhood adversity and accelerated female reproductive events.

DATA SOURCES

PubMed, Web of Science, and Embase were systematically searched from September 22, 2022 to September 23, 2022.

STUDY ELIGIBILITY CRITERIA

Observational cohort, cross-sectional, and case-control studies in human populations were included if they reported the time of reproductive events for female individuals with experience of childhood adversity and were published in English.

METHODS

Two reviewers independently screened studies, obtained data, and assessed study quality, and conflicts were resolved by a third reviewer. Dichotomous outcomes were evaluated using meta-analysis, and pooled odds ratios and 95% confidence intervals were generated using random-effects models. Moderation analysis and meta-regression were used to investigate heterogeneity.

RESULTS

In total, 21 cohort studies, 9 cross-sectional studies, and 3 case-control studies were identified. Overall, female individuals with childhood adversity were nearly 2 times more likely to report accelerated reproductive events than those with no adversity exposure (odds ratio, 1.91; 95% confidence interval, 1.33-2.76; I2=99.6%; P<.001). Moderation analysis indicated that effect sizes for the types of childhood adversity ranged from an odds ratio of 1.61 (95% confidence interval, 1.23-2.09) for low socioeconomic status to 2.13 (95% confidence interval, 1.14-3.99) for dysfunctional family dynamics. Among the 7 groups based on different reproductive events, including early onset of puberty, early menarche, early sexual initiation, teenage childbirth, preterm birth, pregnancy loss, and early menopause, early sexual initiation had a nonsignificant correlation with childhood adversity (odds ratio, 2.70; 95% confidence interval, 0.88-8.30; I2=99.9%; P<.001). Considerable heterogeneity (I2>75%) between estimates was observed for over half of the outcomes. Age, study type, and method of data collection could explain 35.9% of the variance.

CONCLUSION

The literature tentatively corroborates that female individuals who reported adverse events in childhood are more likely to experience accelerated reproductive events. This association is especially strong for exposure to abuse and dysfunctional family dynamics. However, the heterogeneity among studies was high, requiring caution in interpreting the findings and highlighting the need for further evaluation of the types and timing of childhood events that influence accelerated female reproductive events.

Anxiety, Depression, and Social Skills in Girls with Fragile X Syndrome: Understanding the Cycle to Improve Outcomes

OBJECTIVE

Female patients with fragile X syndrome (FXS), a genetic condition associated with a mutation in the FMR1 gene, are at significantly elevated risk for developing anxiety and depression. This study is designed to better understand these symptoms in school-age girls, particularly as they relate to age, social skills, and functional outcomes.

METHODS

We compared 58 girls aged 6 to 16 years with FXS with 46 age-matched, sex-matched, and developmentally matched peers without FXS on measures of anxiety, depression, social skills, adaptive behavior, and quality of life.

RESULTS

Girls with FXS 10.5 years and older demonstrated significantly higher levels of depression, withdrawal, and social avoidance than girls younger than 10.5 years with FXS ( p -values < 0.01). Girls in the comparison group did not show any age-related differences on these measures. The older FXS cohort also showed associations between social communication and interaction skills, adaptive behavior, and measures of anxiety and depression ( p -values < 0.05) not seen in the comparison group, regardless of age.

CONCLUSION

We found that age seems to play an important role in the development of mood symptoms and that such symptoms are uniquely correlated with social communication and reciprocal social interaction behaviors and adaptive functioning in girls with FXS after puberty. These data suggest a critical window of intervention for girls with FXS in the improvement of social interaction skills and the prevention of social avoidance and symptoms of anxiety and depression, with the ultimate goal of improving quality of life and promoting greater independence.

Urinary neonicotinoid concentrations and pubertal development in Chinese adolescents: A cross-sectional study

BACKGROUND

Animal studies suggest that exposure to certain neonicotinoids may interfere with the normal function of endocrine system in mammals. However, evidence from human studies is limited.

OBJECTIVES

This study conducted a cross-sectional analysis to examine urinary neonicotinoids concentrations in Chinese adolescents and its association with pubertal development.

METHODS

774 urine samples from 439 boys (median age: 13.7 years; 25th-75th percentile: 12.7-14.5 years) and 335 girls (median age: 13.7 years; 25th-75th percentile: 12.7-14.5 years) were collected for determination of ten neonicotinoids (imidacloprid, nitenpyram, acetamiprid, thiacloprid, imidaclothiz, thiamethoxam, clothianidin, dinotefuran, flonicamid, sulfoxaflor) and one metabolite (N-desmethyl-acetamiprid). Urinary creatinine was detected for concentration adjustment. Pubertal development including pubic hair, axillary hair, genitalia (boys), testicular volume (boys) and breast (girls) assessed by Tanner stages and others (spermarche, facial hair for boys and menarche for girls) were obtained by physical examination and questionnaire. Logistic and bayesian kernel machine regression were used to investigate the association between neonicotinoids concentrations and pubertal developments.

RESULTS

High detection rates ranged from 72.0% to 100.0% for all neonicotinoids. Boys and girls with thiacloprid concentration at the >75th percentile had lower stage of genitalia development (OR: 0.83, 95% CI: 0.33-0.93) and higher stage of axillary hair development (OR: 1.46, 95% CI: 1.12-3.41), respectively, compared with those at the <25th percentile. The estimate change in genitalia stage was significantly different at or above the 75th percentile concentration of neonicotinoids mixture compared to the 50th percentile concentration. No associations were found between other urinary neonicotinoids and other indicators of puberty.

CONCLUSIONS

Higher thiacloprid concentration was associated with delayed genitalia development in boys and early axillary hair development in girls. Neonicotinoids mixture was negatively associated with genitalia stage in the joint effect. Given the characteristic of the cross-sectional study, our results need further confirmation of the causal relationship.

Effects of Early Life Adversity on Pubertal Timing and Tempo in Black and White Girls: The National Growth and Health Study

OBJECTIVE

Although exposure to abuse in early life predicts earlier pubertal timing, especially for girls, it is unclear if this association generalizes to nonabuse stressors. In addition, the impact of race on the stress-maturation association remains unknown. To address these issues, we examined whether race moderates the effects of early adversity on pubertal timing and tempo using a longitudinal study design.

METHODS

In a cohort of 9- and 10-year-old Black and White girls, pubertal (areolar and pubic hair) maturation was assessed annually for 7 years. In adulthood, 368 participants (186 Black, 182 White) reported on abuse and nonabuse stressors they experienced from ages 0 to 12 years.

RESULTS

Early life abuse was associated with earlier pubertal timing, as indexed by younger age at menarche (b = -0.22, p = .005, 95% confidence interval [CI] = -0.39 to -0.06) and greater pubic hair development (b = 0.11, p = .003, 95% CI = 0.04 to 0.18), in addition to slower pubertal tempo, as indexed by slower rate of pubic hair (b = -0.03, p < .001, 95% CI = -0.05 to -0.01) and areolar (b = -0.02, p = .02, 95% CI = -0.03 to -0.003) development. These associations were not found for nonabuse adversity. Black girls with early life abuse had greater pubic hair development (b = 0.23, p < .001, 95% CI = 0.12 to 0.35) and were slower in pubic hair tempo (b = -0.07, p < .001, 95% CI = -0.09 to -0.04) than their White counterparts.

CONCLUSIONS

Screening for early life abuse may help address health disparities related to earlier pubertal timing.

Early and precocious puberty during the COVID-19 pandemic

During the year 2020, the COVID-19 pandemic rapidly became a severe health emergency worldwide. In order to contrast the spread of the novel SARS-CoV-2, many countries implemented extraordinary restrictive measures, such as a strict lockdown and school closures. The pandemic had a great impact on children and adolescents' daily life, leading to a much more sedentary lifestyle, to larger use of electronic devices and to an increase in stress-related symptoms. These conspicuous changes acted as disruptors of children's normal development. Since the beginning of the pandemic, many studies reported an increase in the number of precocious puberty cases as well as a faster progression rate of puberty itself, if compared to the pre-pandemic years. In this review, our aim was to evaluate the incidence of new cases of early and precocious puberty during the COVID-19 pandemic, analyzing variations in the timing of puberty and in pubertal progression rate, and to investigate the role of environmental and lifestyle factors during the pandemic in modulating the physiopathology of pubertal development. While a direct effect of SARS-CoV-2 infection remains, at the moment, a remote hypothesis, both physical and psychological factors related to the pandemic seem to have a role in triggering GnRH pulsatile secretion leading to earlier pubertal onset. It is indeed important to stress the need to clarify the exact role of COVID-19 in early pubertal onset comparing data from all over the world; long-term comprehensive studies are also pivotal to explain whether this phenomenon will continue while we resume pre-pandemic habits.

Normal and Premature Adrenarche

Adrenarche is the maturational increase in adrenal androgen production that normally begins in early childhood. It results from changes in the secretory response to adrenocorticotropin (ACTH) that are best indexed by dehydroepiandrosterone sulfate (DHEAS) rise. These changes are related to the development of the zona reticularis (ZR) and its unique gene/enzyme expression pattern of low 3ß-hydroxysteroid dehydrogenase type 2 with high cytochrome b5A, sulfotransferase 2A1, and 17ß-hydroxysteroid dehydrogenase type 5. Recently 11-ketotestosterone was identified as an important bioactive adrenarchal androgen. Birth weight, body growth, obesity, and prolactin are related to ZR development. Adrenarchal androgens normally contribute to the onset of sexual pubic hair (pubarche) and sebaceous and apocrine gland development. Premature adrenarche causes ≥90% of premature pubarche (PP). Its cause is unknown. Affected children have a significantly increased growth rate with proportionate bone age advancement that typically does not compromise growth potential. Serum DHEAS and testosterone levels increase to levels normal for early female puberty. It is associated with mildly increased risks for obesity, insulin resistance, and possibly mood disorder and polycystic ovary syndrome. Between 5% and 10% of PP is due to virilizing disorders, which are usually characterized by more rapid advancement of pubarche and compromise of adult height potential than premature adrenarche. Most cases are due to nonclassic congenital adrenal hyperplasia. Algorithms are presented for the differential diagnosis of PP. This review highlights recent advances in molecular genetic and developmental biologic understanding of ZR development and insights into adrenarche emanating from mass spectrometric steroid assays.

Do I Look Gawky? The Association between Pubertal Asynchrony and Peer Victimization

Pubertal synchrony is defined as the degree of coherence to which puberty-related body changes (e.g., breast development, growth spurt, voice change, underarm hair growth) are coordinated. During the pubertal transition, youth’s body parts grow asynchronously, making each youth’s physical appearance unique. Physical appearance is a known correlate of youth’s psychosocial functioning during adolescence, but we know little about how pubertal asynchrony plays a role in their peer relationships. Using data from an adoption study (the Early Growth and Development Study; n = 413; 237 boys, 176 girls), this study examined the effect of pubertal asynchrony on peer victimization. Results revealed sex-specific effects of pubertal asynchrony; pubertal asynchrony was associated with a higher risk of peer victimization for girls but a lower risk for boys. Findings highlight the intersection of physical development and social context in understanding youth’s experiences of puberty.

Pubarche and Gonadarche Onset and Progression Are Differently Associated With Birth Weight and Infancy Growth Patterns

Context

Controversy exists regarding associations between early-life growth patterns and timing of puberty.

Objective

This work aims to investigate associations between birth anthropometry, early growth patterns, and onset/progression of pubertal milestones in boys and girls.

Methods

Among children examined at birth (1997-2003) and at age 36 months in a mother-child cohort, pubertal Tanner stages (B1-5, PH1-5, G1-5) and testicular volume were examined by trained physicians at 1 to 5 follow-up examinations during childhood and adolescence (672 girls and 846 boys, 2006-2013).With parametric survival models we analyzed associations between birth weight, changes in SD scores (SDS) from birth to 36 months (ΔSDS 0-36 > 0.67 SD defining catch-up growth), and age at pubertal onset/attainment of late pubertal stages/menarche.

Results

A 1-kg higher birth weight was associated with earlier onset of B2+ (thelarche): -3.9 months (CI, -6.7 to -1.1 months), G2+ (gonadarche): -2.7 months (-5.3 to -0.1 months), Tvol3+ (testis size > 3 mL): -2.8 months (CI, -4.9 to -0.7 months), but with later G4+ and PH4+ in boys, and a slower progression from B2 to menarche (5.3 months [CI, 1.2 to 9.4 months]) in girls. Catch-up growth was associated with earlier PH2+ (pubarche) in girls (-4.1 months [CI, -7.6 to -0.6 months]), earlier PH2+ in boys (-3.4 months [CI, -6.6 to -0.2 months]), faster progression from B2 to menarche in girls (-9.1 months [CI, 14.6 to 3.5 months]), and earlier G4+ and PH4+ in boys.

Conclusion

Associations between birthweight and infancy catch-up growth differed for gonadarche and pubarche, and for early and late pubertal markers, with similar patterns in both sexes.

Association of Infant Physical Development and Rapid Growth With Pubertal Onset Among Girls in Rural China

IMPORTANCE

Whether physical development and rapid growth during the first 2 years of life are associated with puberty onset in girls remains unclear.

OBJECTIVE

To examine the associations of infant physical development and rapid growth with the timing of puberty onset in girls.

DESIGN, SETTING, AND PARTICIPANTS

This prospective birth cohort study included girls whose mothers had participated in a randomized, double-blind cluster trial of micronutrient supplementation with a daily capsule of folic acid, iron and folic acid, or multiple micronutrients during pregnancy. A total of 547 singleton girls in rural western China who were born after 2004 were followed up at 3, 6, 12, and 24 months of age and were eligible for long-term follow-up. Of these, 294 adolescent girls (aged 10-12 years), representing 53.7% of the total sample, were included in the follow-up interview that was conducted from June 1 through December 31, 2016. Data analyses were conducted from November 1, 2019, to May 30, 2020.

EXPOSURES

Infant weight and length were assessed at birth and 3, 6, 12, and 24 months of age. Rapid growth, defined as a weight-for-age or length-for-age z score increase of greater than 0.67, was calculated during 5 periods: birth to 3 months, birth to 6 months, 6 to 12 months, 12 to 24 months, and birth to 24 months of age.

MAIN OUTCOMES AND MEASURES

Puberty stage was assessed using the standardized Tanner staging system. Onset of puberty was defined as attaining Tanner stage 2 of breast development or pubic hair growth, and the corresponding age at follow-up was recorded.

RESULTS

Of 294 girls included in the analysis (mean [SD] age, 11.25 [0.57] years), the median age of puberty onset was 11 (interquartile range, 10-11) years. A significant association with puberty onset was found for infancy weight-for-age z score at 12 months of age (adjusted hazard ratio [HR], 1.20; 95% CI, 1.01-1.44) and rapid weight gain from birth to 24 months of age (adjusted HR, 1.40; 95% CI, 1.01-1.93) and birth to 3 months of age (adjusted HR, 1.39; 95% CI, 1.02-1.91). However, length-related indicators during early life were not associated with adolescent puberty onset.

CONCLUSIONS AND RELEVANCE

This study found that a higher weight-for-age z score and rapid weight gain during infancy, particularly from birth to 3 months of age, were associated with an increased likelihood of puberty onset in girls. These findings suggest that weight-related indicators may serve as proxies of puberty onset among adolescent girls.

The NIMH Intramural Longitudinal Study of the Endocrine and Neurobiological Events Accompanying Puberty: Protocol and rationale for methods and measures

Delineating the relationship between human neurodevelopment and the maturation of the hypothalamic-pituitary-gonadal (HPG) axis during puberty is critical for investigating the increase in vulnerability to neuropsychiatric disorders that is well documented during this period. Preclinical research demonstrates a clear association between gonadal production of sex steroids and neurodevelopment; however, identifying similar associations in humans has been complicated by confounding variables (such as age) and the coactivation of two additional endocrine systems (the adrenal androgenic system and the somatotropic growth axis) and requires further elucidation. In this paper, we present the design of, and preliminary observations from, the ongoing NIMH Intramural Longitudinal Study of the Endocrine and Neurobiological Events Accompanying Puberty. The aim of this study is to directly examine how the increase in sex steroid hormone production following activation of the HPG-axis (i.e., gonadarche) impacts neurodevelopment, and, additionally, to determine how gonadal development and maturation is associated with longitudinal changes in brain structure and function in boys and girls. To disentangle the effects of sex steroids from those of age and other endocrine events on brain development, our study design includes 1) selection criteria that establish a well-characterized baseline cohort of healthy 8-year-old children prior to the onset of puberty (e.g., prior to puberty-related sex steroid hormone production); 2) temporally dense longitudinal, repeated-measures sampling of typically developing children at 8-10 month intervals over a 10-year period between the ages of eight and 18; 3) contemporaneous collection of endocrine and other measures of gonadal, adrenal, and growth axis function at each timepoint; and 4) collection of multimodal neuroimaging measures at these same timepoints, including brain structure (gray and white matter volume, cortical thickness and area, white matter integrity, myelination) and function (reward processing, emotional processing, inhibition/impulsivity, working memory, resting-state network connectivity, regional cerebral blood flow). This report of our ongoing longitudinal study 1) provides a comprehensive review of the endocrine events of puberty; 2) details our overall study design; 3) presents our selection criteria for study entry (e.g., well-characterized prepubertal baseline) along with the endocrinological considerations and guiding principles that underlie these criteria; 4) describes our longitudinal outcome measures and how they specifically relate to investigating the effects of gonadal development on brain development; and 5) documents patterns of fMRI activation and resting-state networks from an early, representative subsample of our cohort of prepubertal 8-year-old children.

Prepubertal Internalizing Symptoms and Timing of Puberty Onset in Girls

Stressful environments have been associated with earlier menarche. We hypothesized that anxiety, and possibly other internalizing symptoms, are also associated with earlier puberty in girls. The Lessons in Epidemiology and Genetics of Adult Cancer From Youth (LEGACY) Girls Study (2011-2016) included 1,040 girls aged 6-13 years at recruitment whose growth and development were assessed every 6 months. Prepubertal maternal reports of daughter's internalizing symptoms were available for breast onset (n = 447), pubic hair onset (n = 456), and menarche (n = 681). Using Cox proportional hazard regression, we estimated prospective hazard ratios and 95% confidence intervals for the relationship between 1 standard deviation of the percentiles of prepubertal anxiety, depression, and somatization symptoms and the timing of each pubertal outcome. Multivariable models included age, race/ethnicity, study center, maternal education, body mass index percentile, and family history of breast cancer. Additional models included maternal self-reported anxiety. A 1-standard deviation increase in maternally reported anxiety in girls at baseline was associated with earlier subsequent onset of breast (hazard ratio (HR) = 1.22, 95% confidence interval (CI): 1.09, 1.36) and pubic hair (HR = 1.15, 95% CI: 1.01, 1.30) development, but not menarche (HR = 0.94, 95% CI: 0.83, 1.07). The association of anxiety with earlier breast development persisted after adjustment for maternal anxiety. Increased anxiety in young girls may indicate risk for earlier pubertal onset.

Growth trajectory and pubertal tempo from birth till final height in a girl with Wolf-Hirschhorn syndrome

Growth anomaly is a prominent feature in Wolf-Hirschhorn syndrome (WHS), a rare congenital disorder caused by variable deletion of chromosome 4p. While growth charts have been developed for WHS patients 0–4 years of age and growth data available for Japanese WHS patients 0–17 years, information on pubertal growth and final height among WHS children remain lacking. Growth hormone (GH) therapy has been reported in two GH-sufficient children with WHS, allowing for pre-puberty catch up growth; however, pubertal growth and final height information was also unavailable. We describe the complete growth journey of a GH-sufficient girl with WHS from birth until final height (FH), in relation to her mid parental height (MPH) and target range (TR). Her growth trajectory and pubertal changes during childhood, when she was treated with growth hormone (GH) from 3 years 8 months old till 6 months post-menarche at age 11 years was fully detailed.

The relationship between infancy growth rate and the onset of puberty in both genders

BackgroundIn this study, we examined the hypothesis that weight gain and linear growth during the first years of life influence the onset of puberty both in girls and in boys.MethodsA cohort of 157 healthy children, aged 6-9 years, was evaluated and their growth patterns were analyzed retrospectively. Repeated measures mixed model was used to examine the longitudinal anthropometric data.ResultsGirls with pubertal signs were heavier than their peers starting at 9 months of age (P=0.02), and the difference became more evident over time (P<0.001). Accelerated weight gain between 6 and 15 months of age was found to increase the odds of having a pubertal sign at the study visit (odds ratio (OR)=34.5) after adjusting for birth weight, gestational age and current age, height, weight, and BMI (P=0.004). Anthropometric indices of boys with or without pubertal signs were not significantly different at the study visit, but boys with accelerated height gain between 9 and 15 months of age were more likely to have pubertal signs (OR=15.8) after adjusting for birth weight, gestational age and current age, height, weight, and BMI (P=0.016).ConclusionEarly growth acceleration might be important for the timing of puberty in both genders.

Urinary bisphenol A and pubertal development in Chinese school-aged girls: a cross-sectional study

BACKGROUND

Animal studies suggest that bisphenol A (BPA) may perturb pubertal development in females. However, evidence from human studies is limited.

METHODS

This was a cross-sectional study to investigate the association between BPA exposure and pubertal development in school-aged girls. A total of 655 girls aged 9-18 years were selected from three schools in Shanghai, from May to June 2011. We collected one single spot urine sample from each girl. Urine BPA concentrations were measured by modified high-performance liquid chromatography and categorized according to LOD and the median of those above LOD. Pubertal development status was assessed by using Tanner staging, and age at menarche was collected as a milestone for mid-puberty. Modified Poisson regression was used to estimate adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs).

RESULTS

After adjustment for potential confounders, girls with detected BPA were more likely to have delayed menarche, a mid-puberty event, compared with girls with undetectable BPA; the prevalence ratios (PR) were 0.73 (0.56, 0.95) for those with moderate BPA(LOD-median) and 0.72 (0.52, 0.99) for those with high BPA(>median), respectively. Girls aged 9-12 years with detected BPA were more likely to have reached pubic hair stage 2, the indicator of pubarche; while among girls aged >15 years, those with detected BPA were less likely to have reached pubic hair stage 5, the late stage of pubic hair development.

CONCLUSIONS

BPA exposure was associated with alterations in the timing of pubertal development. Results in the present study should be interpreted with caution because of its cross-sectional nature and the limited sample size in each age group.

Pubertal Progression and Reproductive Hormones in Healthy Girls With Transient Thelarche

CONTEXT

Detailed evaluation of pubertal progression in girls from longitudinal studies is sparse, and the phenomenon of transient thelarche (TT), defined as the appearance, regression, and subsequent reappearance of breast buds, in healthy girls remains undescribed.

OBJECTIVE

To describe TT in terms of pubertal progression, growth, genotypes, and reproductive hormones and to apply new puberty nomograms for breast stages, pubic hair, and menarche.

DESIGN

A prospective, longitudinal population-based study.

PATIENTS OR OTHER PARTICIPANTS

Ninety-eight healthy Danish schoolchildren (Caucasian girls) followed longitudinally as part of the COPENHAGEN Puberty Study were included in the evaluation of TT. A total of 1466 girls from 2 cross-sectional studies were included in the creation of the puberty nomograms.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Pubertal progression, specifically thelarche, reproductive hormones, genotype, and growth.

RESULTS

Twelve of 98 (12%) girls experienced TT. A larger proportion of girls with TT entered puberty by the pubarche pathway (50%) compared with girls with normal progression (15.4%), P = 0.014. Girls with TT progressed through puberty normally when evaluated using puberty nomograms. Reproductive hormones and growth velocity were lower at the first (transient) thelarche than the second (permanent) thelarche.

CONCLUSION

TT is a frequent phenomenon that appears to be a peripheral occurrence independent of central puberty. It does not appear to affect subsequent pubertal progression as evaluated by our new puberty nomograms.

Infection and pubertal timing: a systematic review

The decline in age of pubertal timing has serious public health implications ranging from psychosocial adjustment problems to a possible increase in reproductive cancers. One biologically plausible explanation for the decline is a decrease in exposures to infections. To systematically review studies that assess the role of infection in pubertal timing, Medline, Web of Science and EMBASE were systematically searched and retrieved studies were reviewed for eligibility. Eligible studies examined the association between infections, including microbial exposures, and physical pubertal characteristics (breast, genitalia and pubic hair development) or age at menarche. We excluded studies that were published in a language other than English, focused on precocious puberty, were case studies, and/or included youth with autoimmune diseases. We report on study design, population characteristics, measurement of infection and puberty and the main effects of infection on pubertal development. Based on our search terms we identified 1372 unique articles, of which only 15 human and five animal studies met our eligibility criteria. Not all studies examined all outcomes. Infection was associated with later breast development (4/4 human studies), with less consistent evidence for genitalia and pubic hair development. Seven studies assessed age at menarche with inconsistent findings (three supporting later, four no association). We conclude that a small but consistent literature supports that infection is associated with later breast development; the evidence for other pubertal events and age at menarche is less clear. Where fewer childhood infections coincide with the rise in incidence of hormone-related cancers.

Pubertal Onset in Boys and Girls Is Influenced by Pubertal Timing of Both Parents

CONTEXT

Epidemiological evidence on maternal and paternal heritability of the wide normal variation within pubertal timing is sparse.

OBJECTIVE

We aimed to estimate the impact of parental pubertal timing on the onset of puberty in boys and girls.

DESIGN

Annual pubertal examinations of healthy children in a longitudinal cohort study. Information on parental timing of puberty (earlier, comparable to, or later compared to peers) and menarche age was retrieved from questionnaires.

PARTICIPANTS

A total of 672 girls and 846 boys.

MAIN OUTCOME MEASURES

Age at onset of pubic hair (PH2+), breasts (B2+), and menarche in girls; and PH2+, genital stage (G2+), and testis >3 mL with orchidometer (Tvol3+) in boys.

RESULTS

In boys, pubertal onset was significantly associated with pubertal timing of both parents. PH2+ and Tvol3+ were earlier: -11.8 months (95% confidence interval, -16.8, -6.8)/-8.9 (-12.8, -4.9), and -9.5 (-13.9, -5.1)/-7.1 (-10.4, -3.7) if the father/mother, respectively, had early pubertal development compared to late. In girls, menarche was significantly associated with both parents' pubertal timing: -10.5 months (-15.9, -5.1)/-10.1 (-14.3, -6.0) if father/mother had early pubertal development compared to late. For the onset of PH2+ and B2+ in girls, estimates were -7.0 months (-12.6, -1.4) and -4.1 (-10.6, +2.4)/-6.7 (-11.0, -2.5), and -6.7 (-11.0, -2.0) for fathers/mothers, respectively. Maternal age of menarche was significantly associated with the onset of all pubertal milestones except PH2+ in girls.

CONCLUSIONS

Maternal as well as paternal pubertal timing was a strong determinant of age at pubertal onset in both girls and boys. Age at breast and pubic hair development in girls, which has declined most during recent years, seemed to be least dependent on heritability.

Educational Needs of Adolescents Regarding Normal Puberty and Menstrual Patterns

OBJECTIVE

The study aimed to determine the level of knowledge and the sources of information about normal puberty and menstrual patterns in Turkish schoolgirls from İstanbul.

METHODS

The study sample was comprised of 922 randomly chosen schoolgirls. A questionnaire survey of knowledge of normal pubertal development and menstrual patterns was conducted.

RESULTS

The age of the girls ranged between 10 and 17 years and 82.3% had had menarche. The leading source of pubertal information was the mothers (84.2%). There was no statistically significant relationship between the mothers' education level and the level of knowledge of the students about pubertal development (p>0.05). The main source for 18% of students was their teacher, but only 6% had a preference for their teacher providing education on this topic. Students who attained menarche preferred education about puberty to be given by health professionals and to both genders at the same setting (p<0.01). A total of 31.5% of students thought that the first symptom of puberty was acne. Half (50.7%) of the students did not know the time period between the beginning of puberty and menarche. The girls who had attained menarche were more knowledgeable about puberty, largely through their own experience.

CONCLUSION

This study shows that schoolgirls have an insufficient level of knowledge about normal puberty. Education programs must be conducted for students and their parents.

Gender-related sexual abuse experiences reported by children who were examined in an emergency department

The purpose of this study was to examine the experiences of sexual abuse by 95 children of two gender groups to determine differences in their reported sexual exploits by perpetrators. Significant differences between female and male children were reported. Male child-victims experienced more anal penetration by penis (54.5%, 10.7% respectively) and finger (27.3%, 2.7% respectively), however; female child-victims experienced more mouth contact to their genitalia (22.7%, 10.0% respectively) and body kisses (47.9%, 9.1% respectively). A more gender-specific approach could help to facilitate prevention, and produce better outcomes.

Body fat, muscular and cardiorespiratory fitness according to sexual maturation among Brazilian adolescents from a town of German colonization

OBJECTIVE

To analyze the health-related physical fitness according to stages of sexual maturation in Brazilian adolescents (10 to 17 years-old) living in a small town of German colonization.

METHODS

This study was based on a broader project, a school-based cross-sectional epidemiological study conducted with adolescents from public schools (141 males and 129 females) in São Bonifácio, Southern Brazil. The Fitnessgram® battery of tests was applied (body fat percentage, back-saver sit and reach test, curl-up and modified pull-up tests and 20m shuttle run test). Sexual maturation was self-assessed through stages of pubic hair development, being classified from P1 to P5. Results were analyzed by one-way variance analysis, Bonferroni post hoc and Kruskal-Wallis tests.

RESULTS

In boys, body fat percentage was 11.4% higher in the P1 stage (p=0.04) and 10.2% higher in the P3 stage (p=0.01), compared to P5. The differences between maturational stages occurred in flexibility (5.1cm increase; p=0.03), curl-up (p=0.04), and pull-up tests (p<0.01) from stages P2 to P5. For girls, the mean VO2max values ​​were lower for those at the final maturation stages (p<0.01).

CONCLUSIONS

The differences between stages of sexual maturation were observed in body fat percentage and muscle fitness for males and cardiorespiratory fitness for females. Effective measures to promote physical fitness should be addressed at early maturation stages for boys and for more mature girls.

Is soy intake related to age at onset of menarche? A cross-sectional study among adolescents with a wide range of soy food consumption

Background

Early onset of menarche may negatively influence the future health of adolescent girls. Several factors affect the timing of menarche but it is not clear if soy foods consumption around pubertal years plays a role; thus, we examined its relation to age at onset of menarche (AOM) in a high soy-consuming population.

Methods

We conducted a cross-sectional study on 339 girls ages 12–18 years attending middle and high schools near two Seventh-day Adventist universities in California and Michigan using a web-based dietary questionnaire and physical development tool. Soy consumption (categorized as total soy, meat alternatives, tofu/traditional soy, and soy beverages) was estimated from the questionnaire, while AOM was self-reported. Data analyses included descriptive statistics, Cox proportional hazards ratios, Kaplan-Meier curves and Poisson regression with adjustment for relevant confounders.

Results

Mean (SD) intakes were: total soy,12.9 (14.4) servings/week; meat alternatives, 7.0 (8.9) servings/week; tofu/traditional soy foods, 2.1 (3.8) servings/week; soy beverages, 3.8 (6.3) servings/week. Mean AOM was 12.5 (1.4) y for those who reached menarche. Consumption of total soy and the 3 types of soy foods was not significantly associated with AOM and with the odds for early- or late-AOM. Adjustment for demographic and dietary factors did not change the results.

Conclusion

Soy intake is not associated with AOM in a population of adolescent girls who have a wide range of, and relatively higher, soy intake than the general US population. Our finding suggests that the increasing popularity of soy in the US may not be associated with AOM.

Acne vulgaris in preadolescent children: recommendations for evaluation

Acne vulgaris in infants and children often triggers extensive laboratory evaluation out of concern about associated endocrinopathy. Clinical parameters to help guide evaluation of these children have not been defined. This was a retrospective chart review of 24 preadolescent patients with acne and a review of related medical literature. Two age-related subsets were identified: 12 patients who developed acne before the age of 15 months, 75% male, with comedonal and inflammatory lesions; and 12 patients who developed acne between the ages of 2 and 7 years, 75% female, with primarily comedonal lesions. Laboratory evaluation in 13 of the patients was unremarkable. Bone age was advanced in 1 of the 11 children imaged. Premature adrenarche was diagnosed in four patients; all four had additional clinical signs of puberty and growth parameters >90th percentile. None required additional treatment. Our cohort of preadolescent children presenting with acne included an equal number of patients in two distinct subsets: infantile and childhood-onset acne. Literature review identified a rare third subset presenting with acne, signs of advanced puberty, and associated endocrinopathy. There was no evidence of endocrinopathy in our patients with infantile acne. Two-thirds of our patients with childhood-onset acne had no additional clinical signs of puberty and no evidence of endocrinopathy. A focused history and physical examination is sufficient to evaluate the majority of infants and children with acne. Hand X-ray for bone age is a useful screening test. Further evaluation and endocrinology referral are warranted in preadolescents with acne and advanced bone age or additional clinical evidence of early puberty.

Examining the developmental interface of cortisol and depression symptoms in young adolescent girls

Despite the substantial amount of data supporting a link between HPA-axis functioning and depression, the ontogeny of this association is not known. The aim of the present study was to contribute data on the developmental interface of HPA-axis functioning and depression in girls by testing associations between repeated measures of depression symptoms and cortisol levels in childhood and early adolescence. Girls (N=232) and their mothers, who were participating in a longitudinal study, were interviewed about depression symptoms annually from ages 9 to 12 years. Cortisol was assayed from saliva at ages 10 and 12 years upon arrival to the lab and following administration of the cold pressor task (CPT). Time of day of collection of saliva and level of pubertal development were included as covariates in model testing. Although most girls did not show an increase in cortisol in response to the CPT, lower levels of output during the CPT were associated with higher levels of depression symptoms. These findings were observed only for cortisol levels assessed at age 12 years. Girls with low levels of cortisol output at age 12, and decreases in output from ages 10 to 12, had stable or slightly increasing depression symptoms from ages 9 to 12 years. We conclude that associations between HPA-axis functioning and depression emerge as early as age 12. However, individual differences in cortisol levels at age 12 also were associated with depression symptoms at earlier ages. The data suggest two possibilities: (1) that childhood depression is associated with HPA-axis dysregulation, but that age related changes in the sensitivity or plasticity of the HPA-axis may result in a delay in the emergence of such an association, or (2) that dysregulation of the functioning of the HPA-axis develops following repeated experience of depression symptoms.

The pubertal transition in 179 healthy Danish children: associations between pubarche, adrenarche, gonadarche, and body composition

BACKGROUND

Pubertal onset is usually defined by breast development in girls and testicular growth in boys. Pubarche is defined as the attainment of pubic hair and is considered as a sign of pubertal transition. Pubarche is preceded by a gradual increase in production of adrenal androgens, DHEA and Δ4-androstenedione (Adione), a process termed adrenarche.

OBJECTIVE

To study the natural course of pubertal transition and the associations with adrenarche, body fat, and linear growth.

DESIGN AND METHODS

A longitudinal study of 179 healthy children (89 girls) with higher socioeconomic background examined every 6 months for 5 years. Pubic hair stage, breast stage, genital stage, testicular volume (TV), height, weight, and four skinfolds were measured.

RESULTS

In girls, median age (25th and 75th percentiles) at thelarche (B2+) was 10.1 years (9.3-10.9). In boys, median age at attaining a TV >3 ml was 11.5 years (10.9-12.0). Median age at pubarche (PH2+) was 10.9 years (10.3-11.4) in girls and 11.6 years (10.8-12.4) in boys. Only 6.8% (4/59) of the girls and 24.6% (15/61) of the boys developed pubic hair as the first isolated sign of puberty. Serum DHEAS and Adione increased with age, although the increase in Adione was most pronounced in girls. No associations between early age at thelarche/testicular growth and increased body fat (BMI and sum of four skinfolds) were observed.

CONCLUSION

Danish children rarely experience pubarche as the first sign of puberty. No associations between age at pubertal onset and body composition were found. Circulating levels of Adione, but not DHEAS, increased with the onset of puberty, although with large interindividual variability.

Birth size and later central obesity among adolescent girls of Asian, White, and Mixed ethnicities

Birth size has important implications for health and disease in adulthood. This study examined the association of birth size with central body fat distribution in late adolescence. Data were from a cross-sectional survey of adolescent girls (N = 143, 13-18y) of Asian, White and Mixed Asian-white ethnicity collected in 2005-2007 in Hawai'i, USA. Central body fat distribution was assessed with dual-energy x-ray absorptiometry and birth size from birth certificates and parent recall. Food diaries (3-day) were used to determine energy intake and metabolic equivalents of energy expenditure. The proportion of Asian ancestry was determined by questions and anthropometry was performed. T-tests compared groups, and multiple regression examined predictors of central body fat distribution, adjusting for potential confounders. Asian girls had a lower mean weight and gestational age at birth than White girls, and a lower mean dietary fat intake in adolescence. Girls of Asian and Mixed Asian-white ancestry had a more body fat distribution than White girls. Lower birth weight was associated with greater central body fat distribution (0.1 or 10% higher central body fat distribution for every 10 grams lower birth weight), after adjusting for age, ancestry, physical activity, energy intake, and bi-iliac breadth, and gestational age. Further adjusting for birth length attenuated the birth weight effect, and shorter birth length was the significant predictor of central body fat distribution. (0.1 or 10% higher central body fat distribution for every 0.01mm shorter length). If confirmed, these findings would suggest that linear growth may be more relevant to metabolic programming than growth in mass.

Life-course origins of the ages at menarche and menopause

A woman's age at menarche (first menstrual period) and her age at menopause are the alpha and omega of her reproductive years. The timing of these milestones is critical for a woman's health trajectory over her lifespan, as they are indicators of ovarian function and aging. Both early and late timing of either event are associated with risk for adverse health and psychosocial outcomes. Thus, the search for a relationship between age at menarche and menopause has consequences for chronic disease prevention and implications for public health. This article is a review of evidence from the fields of developmental biology, epidemiology, nutrition, demography, sociology, and psychology that examine the menarche-menopause connection. Trends in ages at menarche and menopause worldwide and in subpopulations are presented; however, challenges exist in constructing trends. Among 36 studies that examine the association between the two sentinel events, ten reported a significant direct association, two an inverse association, and the remainder had null findings. Multiple factors, including hormonal and environmental exposures, socioeconomic status, and stress throughout the life course are hypothesized to influence the tempo of growth, including body size and height, development, menarche, menopause, and the aging process in women. The complexity of these factors and the pathways related to their effects on each sentinel event complicate evaluation of the relationship between menarche and menopause. Limitations of past investigations are discussed, including lack of comparability of socioeconomic status indicators and biomarker use across studies, while minority group differences have received scant attention. Suggestions for future directions are proposed. As research across endocrinology, epidemiology, and the social sciences becomes more integrated, the confluence of perspectives will yield a richer understanding of the influences on the tempo of a woman's reproductive life cycle as well as accelerate progress toward more sophisticated preventive strategies for chronic disease.

National estimates of the pubertal milestones among urban and rural Chinese girls

PURPOSE

To provide clinically meaningful, normative reference data that describe pubertal timing indicators among urban and rural Chinese girls.

METHODS

Girls of Chinese Han ethnicity from grade 1 in elementary schools through grade 12 in junior high schools in eight regions participated in China Puberty Research Collaboration from October 2010 to May 2011. At examination, stages of breast and pubic hair development were assessed by trained physicians. Data on menses were collected through questionnaire survey.

RESULTS

A total of 15,388 girls aged 6.0-18.9 years participated in this collaboration study. Among them, approximately 53.5% (8,238) came from rural areas. The median ages at stage 2 of breast development of Chinese girls were 9.18 (95% confidence interval: 8.91-9.44) years and at stage 2 for pubic hair growth were 11.65 (95% confidence interval: 11.41-11.90) years. Girls with body mass index ≥85th percentile had earlier age for B2 (Tanner stage 2 for breast development), B3 (Tanner stage 3 for breast development), PH2 (Tanner stage 2 for pubic hair development), PH3 (Tanner stage 3 for pubic hair development), and menarche compared with girls with body mass index < 85th percentile. Urban girls achieved PH2, PH3, and menarche at a much earlier age than rural girls, except for B2 and B3 attainment. Mean menarcheal age is 12.43 years.

CONCLUSIONS

This study presented up-to-date data on female pubertal timing in a national sample of Chinese Han ethnicity girls and separately for urban and rural areas.

Pubertal pathways and the relationship to anthropometric changes in childhood: The Fels longitudinal study

OBJECTIVE

To examine the relationship of the initial manifestation of pubertal development in children to anthropometric measurements recorded during the early childhood and adolescence.

METHODS

The Fels Longitudinal study is an observational study of growth and development of healthy white children. A total of 109 boys and 75 girls with serial self-assessments of Tanner stages of genital/breast and pubic hair developments provided data for a longitudinal analysis with a linear mixed model.

RESULTS

About 11.0% of boys and 22.7% of girls witnessed the appearance of pubic hair (adrenarche) prior to the onset of genital/breast growth (gonadarche/thelarche) and about 13.7% of boys and 22.7% of girls experienced the onset of gonadarche/thelarche prior to adrenarche. The remaining 75.3% of boys and 54.7% of girls were concordant for adrenarche and gonadarche/thelarche. During the first two years of life, boys and girls with earlier gonadarche and thelarche than adrenarche were found to have more rapid weight gain than those with earlier adrenarche than gonadarche/thelarche. During early childhood from age 2 - 7 years, those girls with early thelarche had higher body mass index (BMI) and waist circumference to height ratio (waist/height) than those with early adrenarche. In children of ages 8 - 20, girls with early gonadarche had higher BMI z-scores than those with early adrenarche.

CONCLUSION

Girls with early thelarche and later adrenarche, have more rapid mean weight gain during the first two years of life, higher BMI and waist/height during early childhood, and higher BMI z-scores during adolescence. Boys with early gonadarche and later adrenarche experienced more rapid weight gain during the first two years of life than boys with early adrenarche and later gonadarche. In other words, girls with early thelarche are more likely to be triggered by early accumulation of fat mass than those with early adrenarche.

A potential mechanism for the sexual dimorphism in the onset of puberty and incidence of idiopathic central precocious puberty in children: sex-specific kisspeptin as an integrator of puberty signals

The major determinants of the variability in pubertal maturation are reported to be genetic and inherited. Nonetheless, nutritional status contributes significantly to this variability. Malnutrition delays puberty whereas obesity has been associated to a rise in Idiopathic Central Precocious Puberty (ICPP) in girls. However, epidemiology data indicate that contribution of obesity to early puberty varies significantly among ethnic groups, and that obesity-independent inheritable genetic factors are the strongest predictors of early puberty in any ethnic group. In fact, two human mutations with confirmed association to ICPP have been identified in children with no history of obesity. These mutations are in kisspeptin and kisspeptin receptor, a ligand/receptor pair with a major role on the onset of puberty and female cyclicity after puberty. Progressive increases in kisspeptin expression in hypothalamic nuclei known to regulate reproductive function has been associated to the onset of puberty, and hypothalamic expression of kisspeptin is reported to be sexually dimorphic in many species, which include humans. The hypothalamus of females is programmed to express significantly higher levels of kisspeptin than their male counterparts. Interestingly, incidence of ICPP and delayed puberty in children is markedly sexually dimorphic, such that ICPP is at least 10-fold more frequent in females, whereas prevalence of delayed puberty is about 5-fold higher in males. These observations are consistent with a possible involvement of sexually dimorphic kisspeptin signaling in the sexual dimorphism of normal puberty and of pubertal disorders in children of all ethnicities. This review discusses the likelihood of such associations, as well as a potential role of kisspeptin as the converging target of environmental, metabolic, and hormonal signals, which would be integrated in order to optimize reproductive function.

Leuprolide stimulation testing for the evaluation of early female sexual maturation

CONTEXT

Low concentrations of serum LH and/or oestradiol (E(2)) in girls with early physical signs of precocious puberty pose a diagnostic challenge.

OBJECTIVE

To assess the diagnostic value of the leuprolide stimulation test in female precocious puberty.

DESIGN

Retrospective Chart Review.

SETTING

Outpatient clinic.

PATIENTS AND INTERVENTION

Thirty-nine girls, 6.9 (1.4) years, with premature stage II-III breast development, with or without pubarche, underwent stimulation testing with subcutaneous leuprolide (20 microg/kg) with the following hormonal measurements in serum: FSH, LH, oestradiol at baseline; FSH and LH at 1 and 2 h; oestradiol at 24 h. Twelve girls with isolated pubarche were also tested with leuprolide.

MAIN OUTCOME MEASURE

A pubertal hormonal pattern was defined as at least one of the following: a baseline serum level of LH > or = 0.3 U/l, a baseline oestradiol > or = 37 pmol/l (10 ng/l), a stimulated (peak) LH > or = 5.0 U/l, a stimulated oestradiol > or = 184 pmol/l (50 ng/l) to leuprolide. The hormonal response was related to the clinical course during a period of observation of at least 6 months.

RESULTS

Following leuprolide stimulation, the hormonal response was concordant with pubertal progression (n = 23) or lack thereof (n = 16) in all children. At baseline, pubertal serum concentrations of LH and/or oestradiol were associated with pubertal progression in all, while serum prepubertal LH and/or oestradiol concentrations were associated with pubertal progression in approximately 50% of the patients.

CONCLUSIONS

In girls with early clinical signs of precocious puberty and low serum concentrations of LH and oestradiol in random samples, the LH and oestradiol responses to leuprolide stimulation accurately predict pubertal progression.