Abstract
BackgroundEarly puberty is associated with higher risk of adverse health and behavioral outcomes throughout adolescence and adulthood. US girls are experiencing earlier puberty with substantial racial/ethnic differences. We examined the association between breastfeeding and pubertal timing to identify modifiable risk factors of early puberty and potential sources of racial/ethnic differences in the timing of pubertal development.MethodsA prospective cohort study of 3331 racially/ethnically diverse girls born at Kaiser Permanente Northern California (KPNC) between 2004 and 06. All data were obtained from KPNC electronic clinical and administrative datasets. Mother-reported duration of breastfeeding was obtained from questionnaires administered at each ‘well-baby’ check-up exam throughout the baby’s first year and categorized as ‘Not breastfed’, ‘Breastfed < 6 months’, and ‘Breastfed ≥6 months’. Pubertal development data used Tanner stages assessed by pediatricians during routine pediatric checkups starting at age 6. Pubertal onset was defined as transition from Tanner Stage 1 to Tanner Stage 2+ for breast (thelarche) and pubic hair (pubarche). Weibull regression models accommodating for left, right, and interval censoring were used in all analyses. Models were adjusted for maternal age, education, race/ethnicity, parity and prepubertal body mass index (BMI). We also examined race/ethnicity as a potential effect modifier of these associations.ResultsNot breastfeeding was associated with earlier onset of breast and pubic hair development compared to breastfeeding ≥6 months (adjusted hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 1.07–1.46; HR: 1.24; 95% CI: 1.05–1.46, respectively). Breastfeeding for < 6 months was also associated with the risk of earlier pubic hair development (HR: 1.14; 95% CI: 1.00–1.30, compared to breastfeeding ≥6 months). Inclusion of girls’ prepubertal BMI slightly attenuated the association between breastfeeding and timing of breast onset but remained significant. The association between not breastfeeding and early breast development may be stronger among African American girls (HR: 1.92; 95% CI: 1.01–3.66, compared to breastfeeding ≥6 months) than other racial/ethnic groups.ConclusionsBreastfeeding is an independent predictor of pubertal onset in girls, and the strength of the association may vary by race/ethnicity. Providing breastfeeding support and lactation education for high risk mothers may help prevent earlier pubertal onset and promote positive health outcomes later in life.
Highlights
Puberty is associated with higher risk of adverse health and behavioral outcomes throughout adolescence and adulthood
Using the Kaiser Permanente Northern California (KPNC) clinical and administrative databases, including its electronic health record (EHR) system, we identified a cohort of mother-daughter pairs who met the following eligibility criteria
Girls who were not breastfed were more likely to experience earlier thelarche compared with girls who were breastfed ≥6 months (HR: 1.25; 95% Confidence interval (CI): 1.07–1.46) (Table 2)
Summary
Puberty is associated with higher risk of adverse health and behavioral outcomes throughout adolescence and adulthood. Girls who undergo earlier puberty are at higher risk of emotional and behavioral problems including depression, eating disorders, substance use, early initiation of sexual behavior, teen pregnancy, and sexual abuse [2,3,4,5,6,7]. They are at increased risk for serious health conditions later in life, including reproductive cancers and cardiovascular disease [2, 8]. Racial/ethnic differences in age of pubertal onset may lead to worse health outcomes for racial/ethnic minorities in the US; understanding these differences is crucial to efforts to narrow racial/ethnic health disparities
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