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

Anuradhaa Subramanian,Jan Idkowiak,Wiebke Arlt,Krishnarajah Nirantharakumar,Konstantinos A Toulis,Shakila Thangaratinam

doi:10.1530/eje-20-0296

Abstract

ContextThe incidence of gestational diabetes mellitus (GDM) has been on the rise, driven by maternal obesity. In parallel, pubertal tempo has increased in the general population, driven by childhood obesity.ObjectiveTo evaluate the available evidence on pubertal timing of boys and girls born to mothers with GDM.Data sourcesWe searched MEDLINE, EMBASE, CINAHL Plus, Cochrane library and grey literature for observational studies up to October 2019.Study selection and extractionTwo reviewers independently selected studies, collected data and appraised the studies for risk of bias. Results were tabulated and narratively described as reported in the primary studies.ResultsSeven articles (six for girls and four for boys) were included. Study quality score was mostly moderate (ranging from 4 to 10 out of 11). In girls born to mothers with GDM, estimates suggest earlier timing of pubarche, thelarche and menarche although for each of these outcomes only one study each showed a statistically significant association. In boys, there was some association between maternal GDM and earlier pubarche, but inconsistency in the direction of shift of age at onset of genital and testicular development and first ejaculation. Only a single study analysed growth patterns in children of mothers with GDM, describing a 3-month advancement in the age of attainment of peak height velocity and a slight increase in pubertal tempo.ConclusionsPubertal timing may be influenced by the presence of maternal GDM, though current evidence is sparse and of limited quality. Prospective cohort studies should be conducted, ideally coupled with objective biochemical tests.

Highlights

Puberty marks an important period in the dynamics of childhood development characterised by fundamental physical, cognitive and psychological transformation
Eleven articles were excluded at this stage: four articles were conference proceedings, oral presentations or commentary articles (14, 15, 16, 17); two articles did not include any of the outcomes we were interested in (18, 19); one article did not analyse gestational diabetes mellitus (GDM) as a predictor for pubertal timing due to an insufficient number of subjects with GDM (20); two articles did not provide a comparator cohort (21, 22); two articles only reported Tanner stage at baseline and did not consider age/timing of puberty (23, 24)
The study did not observe any association (adjusted mean monthly difference: 0.7 (−2.9, 4.3)) (Table 3). This is the first systematic review that comprehensively explores the relationship between maternal GDM and pubertal timing; stratified by offspring gender

Summary

Introduction

Puberty marks an important period in the dynamics of childhood development characterised by fundamental physical, cognitive and psychological transformation. The attainment of adult-like secondary sexual characteristics, rapid growth, changes of body composition and achieving fertility are the main physical outcomes of puberty. As a consequence of the maturation of the hypothalamic–pituitary–gonadal axis with subsequent incremental, finely orchestrated gonadal sex steroid production, typical physical changes occur in a successive fashion. In girls, this usually starts with thelarche (onset of breast development) and pubarche 184:1 and pubertal timing pubic hair), followed by a peak growth spurt culminating in menarche (first menstruation) (1). Testicular enlargement and pubarche are the first physical signs of puberty followed by peak growth spurt and spermarche (development of sperm) with the occurrence of the first ejaculation

Objectives

Methods

Results

Conclusion