Pubertal course of persistently short children born small for gestational age (SGA) compared with idiopathic short children born appropriate for gestational age (AGA)

Abstract

Objective: Few data are available on the pubertal development of children born small for gestational age (SGA) who fail to show catch-up growth. Design: A longitudinal analysis compared the pubertal course of persistently short children born SGA compared to children with idiopathic short stature who were appropriate for gestational age (AGA). One hundred and twenty-eight short children (height SDS , 21.7), including 76 (31 boys) born SGA and 52 (22 boys) born AGA, were regularly followed from early childhood to completion of puberty. Results: Puberty was attained at normal age (10.5 -14 years in boys, 9.5-13 years in girls) for most children in both the SGA and AGA groups (boys, 80% and 77%; girls, 76% and 78% respectively). The duration of puberty was similar in the SGA and AGA groups. Menarche occurred at normal age range but was significantly earlier in the SGA girls (P , 0.01 by ANOVA). Despite the similar total pubertal growth, the patterns of growth differed significantly: SGA group -accelerated growth and bone maturation rates from onset of puberty with peak height velocity at Tanner stages 2-3, followed by a decelerated growth rate and earlier fusion of the epiphyses; AGA group -steady progression of bone elongation and maturation throughout puberty (pubertal growth, P , 0.05 in both sexes; bone maturation, P , 0.001 in both sexes). Final height in the SGA group was compromised compared with their target height (P , 0.001). Conclusion: Children born SGA have a normal pubertal course with a distinct pubertal growth pattern. This pattern may represent an altered regulation of their growth modalities.

Observed and Predicted Total Pubertal Growth during Treatment with Growth Hormone in Adolescents with Idiopathic Growth Hormone Deficiency, Turner Syndrome, Short Stature, Born Small for Gestational Age and Idiopathic Short Stature: KIGS Analysis and Review

“…Growth analyses of TPG from Lazar et al [39] and Vicens-Calvet et al [40] suggest that TPG in SGA is normal for age at puberty onset and sex. During long-term GH therapy TPG was documented in the studies of Rosilio et al [41] and Boonstra et al [42].…”

Examination of US Puberty-Timing Data from 1940 to 1994 for Secular Trends: Panel Findings

“…52 The relationship of body fat and puberty timing is reviewed by Kaplowitz. 53 Some studies found that children who had a low birth weight (defined as Ͻ2500 g) or were small for gestational age (typically defined as birth weight Ͻ10th percentile for gestational age and gender) are more likely to have advanced timing of puberty (girls and boys 54 ; girls only 55 ); however, other results are mixed. For example, 1 study found an association between small size at birth and early puberty in girls but not boys, 56 and another found no differences between pubertal timing in children who were born at very low birth weight (Ͻ1251 g) and control subjects of both genders.…”

Low Birth Weight and Male Reproductive Function

“…The change in the timing of onset of puberty appears to show a gender dimorphism, in that girls, but not boys, start puberty a few months earlier than normal if born SGA [56] and progress more quickly through puberty [7, 57, 58]. Another study, however, found that pubertal onset was in the early-normal range for gender, growth pattern during the pubertal spurt was different, but total pubertal height gain was comparable [59]. Overall, changes in pubertal maturation due to low birth weight do not appear to be profound [60].…”