The Effects of the COVID-19 Pandemic on Pubertal Development in Girls: A Retrospective Evaluation of Girls Presenting with Precocious Puberty Before and During the Pandemic

Abstract

Objective: The timing of pubertal onset is a complex biological process influenced by various factors, many of which remain poorly understood. A notable increase in early puberty cases was observed during the COVID-19 pandemic. This study evaluated girls presenting with early or precocious puberty both during and in the five years before the pandemic. Methods: Thirty-six girls (Group 1) with suspected early puberty during the COVID-19 pandemic (March 2020–July 2021) and forty girls (Group 2) diagnosed with central precocious puberty between 2015 and 2019 were included. Retrospective data on demographic, anthropometric, clinical, and laboratory findings were analyzed. Results: The median (IQR) age at presentation was 8.07 (1.37) years in Group 1 and 7.89 (1.35) years in Group 2 (p=0.038). No significant differences were observed between the groups regarding height SDS, BMI-SDS, bone age, or Δ target height–predicted adult height SDS. Conclusions: Despite a common association between obesity and early puberty, no differences in BMI were identified in this cohort. Environmental factors related to the pandemic conditions may have influenced the timing of puberty. Larger studies with broader populations are needed for definitive conclusions.

Keywords

• COVID-19 pandemic
• pubertal development
• precocious puberty
• girls

References

1. Latronico AC, Brito VN, Carel JC. Causes, diagnosis, and treatment of central precocious puberty. Lancet Diabetes Endocrinol 2016;4(3):265-74. doi: 10.1016/S2213-8587(15)00380-0. google scholar
2. A Canton APM, Seraphim CE, Brito VN, Latronico AC. Pioneering studies on monogenic central precocious puberty. Arch Endocrinol Metab 2019 22;63(4):438-44. doi: 10.20945/2359-3997000000164. google scholar
3. Zhu J, Kusa TO, Chan YM. Genetics of pubertal timing. Curr Opin Pediatr 2018;30(4):532-40. doi: 10.1097/ MOP.0000000000000642. google scholar
4. Leong A, Vasanwala RF. Early Puberty Trends during the COVID-19 Pandemic in Singapore: A Retrospective Review in a Single Tertiary Center. J ASEAN Fed Endocr Soc 2024;39(1):6-11. doi: 10.15605/jafes.039.01.12. google scholar
5. Verzani M, Bizzarri C, Chioma L, Bottaro G, Pedicelli S, Cappa M. Impact of COVID-19 pandemic lockdown on the early onset of puberty: experience of an Italian tertiary center”. Ital J Pediatr 2021;47(1):52. doi: 10.1186/s13052-021-01015-6. google scholar
6. Goffredo M, Pilotta A, Parissenti I, Forino C, Tomasi C, Goffredo P, et al. Early onset of puberty during COVID-19 pandemic lockdown: experience from two Pediatric Endocrinology Italian Centers. Pediatr Endocrinol Metab 2023;36(3):290-98. doi: 10.1515/jpem-2022-0492 google scholar
7. Chioma L, Chiarito M, Bottaro G, et al. COVID-19 pandemic phases and female precocious puberty: The experience of the past 4 years (2019 through 2022) in an Italian tertiary center. Front Endocrinol (Lausanne) 2023;14:1132769. doi: 10.3389/ fendo.2023.1132769. google scholar
8. Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in girls. Arch Dis Child 1969;44(235):291-303. https:// doi.org/10.1136/adc.44.235.291. google scholar

9. Neyzi O, Bundak R, Gökçay G, Günöz H, Furman A, Darendeliler F et al. Reference Values for Weight, Height, Head Circumference, and Body Mass Index in Turkish Children. J Clin Res Pediatr Endocrinol. 2015;7(4):280-93. google scholar
10. Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. 2nd ed. Stanford, Calif.: Stanford University Press; 1959. google scholar
11. Stagi S, De Masi S, Bencini E, Losi S, Paci S, Parpagnoli M et al. Increased incidence of precocious and accelerated puberty in females during and after the Italian lockdown for the coronavirus 2019 (COVID-19) pandemic. Ital J Pediatr 2020;46(1):165. doi: 10.1186/s13052-020-00931-3. google scholar
12. Oliveira Neto CP, Azulay RSS, Almeida AGFP, Tavares MDGR, Vaz LHG, Leal IRL et al. Differences in the Puberty of Girls before and during the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19(8):4733. doi: 10.3390/ijerph19084733. google scholar
13. Chen Y, Chen J, Tang Y, Zhang Q, Wang Y, Li Q et al. Differences in Precocious Puberty Between Before and During the COVID-19 Pandemic: A Cross-Sectional Study Among Shanghai School-Aged Girls. Front Endocrinol (Lausanne) 2022; 13:839895. doi: 10.3389/ fendo.2022.839895. google scholar
14. Stagi S, Ferrari M, Paiusco G, Moriondo M, Azzari C. Possible Role of Melatonin in Precocious and Accelerated Puberty in Females during the COVID-19 Pandemic. Ital J Pediatrics 2021, preprint. doi.org/10.21203/rs.3.rs-855928/v1 google scholar
15. Lockley SW, Skene DJ, Arendt J, Tabandeh H, Bird AC, Defrance R. Relationship between melatonin rhythms and visual loss in the blind. J Clin Endocrinol Metab. 1997;82(11):3763-70. doi: 10.1210/jcem.82.11.4355. google scholar
16. Teles MG, Bianco SD, Brito VN, Trarbach EB, Kuohung W, Xu S et al. A GPR54-activating mutation in a patient with central precocious puberty. N Engl J Med. 2008;358(7):709-15. doi: 10.1056/NEJMoa073443. google scholar
17. Silveira LG, Noel SD, Silveira-Neto AP, Abreu AP, Brito VN, Santos MG, et al. Mutations of the KISS1 gene in disorders of puberty. J Clin Endocrinol Metab 2010; 95: 2276-80. doi: 10.1210/jc.2009-2421. google scholar
18. Abreu AP, Dauber A, Macedo DB, Noel SD, Brito VN, Gill JC, et al. Central precocious puberty caused by mutations in the imprinted gene MKRN3. N Engl J Med 2013; 368: 2467-75. doi: 10.1056/ NEJMoa1302160. google scholar