Exposure to Diabetes in Utero Is Associated with Earlier Pubertal Timing and Faster Pubertal Growth in the Offspring: The EPOCH Study

Abstract

Objective: To examine the associations of in utero exposure to maternal diabetes with surrogate measures of offspring pubertal timing (age at peak height velocity [APHV]) and speed of pubertal growth (peak height velocity [PHV]).Study design: Data from 77 exposed and 340 unexposed youth followed from age 2 to 19 years (51% non-Hispanic white, 50% females) were analyzed using the Exploring Perinatal Outcomes among Children study, a historical prospective cohort. Maternal diabetes status was collected from obstetric records, and child heights from 2 years to current age from pediatric records. Other covariates were collected during research visits. The Superimposition by Translation and Rotation method, using height measurements (4-52 per participant), modeled APHV and PHV. Accelerated failure time analyses were used to test whether exposure to maternal diabetes was associated with younger APHV and faster PHV. Results:Adjusting for child's sex and race/ethnicity, median APHV was reached ~3 months earlier in youth exposed to maternal diabetes compared with unexposed youth (P < .03). Youth exposed to maternal diabetes had a faster PHV than unexposed youth: exposed females had 10.5% greater median PHV compared with unexposed females and exposed males had a 4.0% greater median PHV compared with unexposed males (p<0.001 for exposure by sex interaction). Conclusions: Our findings provide evidence that exposure to maternal diabetes in utero is associated with earlier pubertal timing and faster pubertal growth. Whether earlier puberty or

Pubertal timing in boys and girls born to mothers with gestational diabetes mellitus: a systematic review

“…Adiposity and 'over-nutrition' can be considered predictors of pubertal timing and principal determinants for the initiation and maintenance of pubertal maturational events (32), hence, the association between maternal GDM and offspring pubertal timing could be mediated by offspring adiposity and pre-adolescence BMI. This is supported by the analysis by Hockett et al (26), in which the association between maternal GDM and age at PHV is attenuated by adjustment for offspring BMI z-score.…”

“…Of the remaining 248, were not relevant to the research question and were excluded on the basis of title and abstract, leaving 18 studies for full-text assessment. Eleven articles were excluded at this stage: four articles were conference proceedings, oral presentations or commentary articles (13)(14)(15)(16); two articles did not include any of the outcomes we were interested in (17,18); one article did not analyse GDM as a predictor for pubertal timing due to an insufficient number of subjects with GDM (19); two articles did not provide a comparator cohort (20,21); two articles only reported Tanner stage at baseline and did not consider age/timing of puberty (22,23). The seven remaining studies were included in the review (Fig.…”

“…age of transition to PH3 was 12.6 (95%CI 12.4, 12.7) for boys born to mothers with GDM compared to the entire cohort's median age of 12.8 (95%CI 12.7, 12.8). In the model with height and weight anthropometrics instead of BMI, median age of transition to PH3 for boys born to mothers with GDM was 12.8 [95%CI 12.6, 13.0] compared to the entire cohort's median Hockett et al(26) did not find a significant association between the age at PHV among boys and the GDM status of their mothers. However, they reported was a 4% increased PHV among boys born to mothers with GDM compared to boys born to mothers without GDM after adjusting for race/ethnicity (Table 3).…”

Using the SITAR Method to Estimate Age at Peak Height Velocity of Children in Rural South Africa: Ellisras Longitudinal Study

“…He concluded that height during puberty needs to be measured only annually and, with slightly lower precision, just four biennial measurements can be sufficient [7]. aPHV and PHV were modeled using the SITAR method and they found that median aPHV was reached approximately three months earlier in youth exposed to maternal diabetes compared with unexposed youth (p < 0.03) [15]. Youth exposed to maternal diabetes had a faster PHV than unexposed youth: exposed girls had a 10.5% greater median PHV compared with unexposed girls, and exposed boys had a 4.0% greater median PHV compared with unexposed boys (p < 0.001 for exposure by sex interaction) [15].…”

Pubertal timing in boys and girls born to mothers with gestational diabetes mellitus: a systematic review

“…Pubic hair development/Pubarche: There was an inconsistent association between maternal GDM and pubarche in girls based on the four primary articles that studied this association. Age at peak height velocity: Hockett et al (27) examined the association between maternal GDM and pubertal timing in the daughters as reflected by growth parameters including peak height velocity (PHV) and age at PHV (APHV). APHV was 10.85 years in girls born to mothers with GDM and 11.12 years in girls born to mothers without GDM, with overlapping confidence intervals ( Table 2).…”