Secular Trends in Precocious Puberty: Increasing Prevalence and Obesity Effect in the Western Black Sea Region

Objective: Precocious puberty is defined as the onset of secondary sexual characteristics before the age of 8 years in girls and 9 years in boys. Although its incidence increased during the COVID-19 pandemic, temporal and regional data remain limited. This study aimed to retrospectively analyze the prevalence of precocious puberty in the Western Black Sea region, its distribution across pandemic normalization periods, and factors associated with treatment requirement. Materials and Methods: A total of 270 patients diagnosed with precocious puberty between May 1, 2021, and April 6, 2024, were evaluated and divided into two periods: Group 1 (June 2021–January 2023; post-COVID-19 early normalization period, n = 204) and Group 2 (January 2023–June 2024; after restrictions were lifted, late period, n = 66). Patients were classified as premature thelarche, premature adrenarche, central precocious puberty (CPP), or progressive puberty. Clinical characteristics, presentation at advanced Tanner stage (≥3), and treatment requirement were compared between groups. Factors associated with treatment necessity were analyzed using logistic regression. Results: Among the 270 patients, 12.5% (n = 34) showed normal pubertal development, while 75.8% (n = 179) were diagnosed with central precocious puberty. In Group 1 (n=204), 53.1% of patients presented at an advanced pubertal stage (Tanner ≥3), compared with 14% in Group 2(n=66) (p = 0.001). Treatment was required in 58.3% (119/204) of patients with CPP or rapidly progressive puberty in Group 1, whereas this rate was 21.2% (14/66) in Group 2 (p <0.001). Logistic regression analysis demonstrated that a family history of precocious puberty, earlier maternal age at menarche, higher body mass index standard deviation score (BMI SDS), and an elevated basal luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratio were significantly associated with treatment requirement. Among treated patients, 76/133 (57,1%) were overweight or obese. Although obesity and reported exposure to endocrine-disrupting chemicals were more frequent in Group 2, BMI was not significantly associated with treatment requirement in this group (p = 0.182). Conclusion: This study demonstrated that, in the Western Black Sea region, precocious puberty during the early post-pandemic period tended to present at more advanced pubertal stages and was associated with a markedly increased need for treatment. A family history of precocious puberty, maternal age at menarche, higher BMI, and the LH/FSH ratio were identified as factors associated with treatment requirement. These findings highlight the importance of early screening and close follow-up in children at risk.