Excess maternal gestational weight gain is associated with early timing of pubertal onset in daughters

摘要

Background: To investigate whether in utero exposure to maternal excess or inadequate gestational weight gain (GWG) is associated with the timing of pubertal onset in girls, and whether the association is mediated by pre-pubertal BMI. Early puberty is associated with a variety of negative health consequences, including adolescent mental health and adulthood chronic conditions, such as cancer. The average age of pubertal onset among girls has declined dramatically over the past few decades. Methods: Prospective cohort study including 2,161 diverse mother-daughter pairs of Kaiser Permanente Northern California (KPNC), where daughters were age 6-11 y. Pubertal onset was assessed using pediatrician-recorded pubertal maturation (Tanner) staging in the KPNC electronic health record (EHR). Maternal total GWG was calculated by subtracting pre-pregnancy weight from the weight immediately prior to birth. All the weights measured before or during pregnancy were obtained from the KPNC EHR and total GWG was categorized according to the 2009 Institute of Medicine (IOM) recommendations as met (referent), inadequate (below recommended GWG), or exceed. We used proportional hazards model with interval censoring, with the outcomes as age of transition from breast stage 1 to 2 + (BR2 + ) or pubic hair stage 1 to 2 + (PH2 + ). Associations were examined without adjustment (Model 1), adjusted for maternal age, girl's race/ethnicity, and gestational age (Model 2), and with girls' pre-pubertal body mass index (Model 3). Results: There was a significant association between excess GWG and earlier timing of pubertal onset (Table 1). Girls whose mother exceeded the IOM recommendation were over 1.5 times more likely to experience earlier onset of breast and pubic hair than those whose mother met the recommendation [adjusted hazard ratio (HR) = 1.61, 95% confidence interval (CI) 1.29-2.01; HR = 1.55, 95%CI 1.17-2.06, respectively]. The associations remained statistically significant after adjusting for girl's pre-pubertal BMI [HR= 1.45, 95% CI 1.16-1.82; HR= 1.38, 95%CI 1.04-1.84, respectively. Inadequate GWG was also associated with earlier pubertal onset, though the associations were attenuated and became non-significant after adjusting for girl's pre-pubertal BMI. Conclusions: We observed independent associations between maternal excess GWG and earlier timing of pubertal onset in girls. The results suggest the importance of monitoring the weight gain among pregnant women to prevent ever-accelerating pubertal maturation in girls as an upstream prevention for a variety of adolescent and adult health conditions.