Precocious puberty is a condition which causes children to experience puberty earlier than their peers. It is substantially more common in girls. Girls are also known to be much more sensitive to environmental triggers of precocious puberty, such as obesity and chemical exposure. Lifestyle is also a significant factor in the development of precocious puberty, particularly in relation to exercise and outdoor time.
A newer cause that researchers have been investigating is the COVID-19 pandemic. As the deadly SARS-CoV-2 virus swept the world, many nations mandated lockdowns. Schools and businesses closed, and some nations (particularly in Europe) limited outdoor time substantially. This radically changed how people worked, socialized, and entertained themselves. The stress of a deadly pandemic stacked on top of lack of social interactions also had devastating mental health effects, especially in those at such a critical age.
The impact that the pandemic had on children’s lives also led to a substantial increase in the cases of precocious puberty. One Italian study found that the number of consultations regarding precocious puberty had more than doubled following the onset of the pandemic. Another Turkish study found that more patients were being treated with hormones to stop precocious puberty than before the pandemic, and also saw more reports of accelerated puberty. It is clear that the pandemic resulted in more cases of precocious puberty, but why it had such an effect is not clear.
Diet and Lifestyle
During quarantines, people consumed more pre-packaged foods than before, and also had more readily available snacks because they were at home. Additionally, physical activity was substantially reduced. People were no longer able to go to school or work, which both generally involve some form of walking, and in many nations were not even able to exercise outside. There was also an All of these led to an increase in weight and body fat percentage.
Increased BMI is one suspected cause of the increase in precocious puberty around the COVID-19 pandemic. Increases in BMI are also associated with increases in leptin, the hormone that indicates fullness. As someone gains weight, the body produces leptin to tell them to eat less. However, the body becomes insensitive to leptin over time, so a person will continue to eat in excess even though their leptin levels are high. Leptin is known to interact with the hormones that trigger puberty, so the increases in BMI associated with quarantine are suspected to have resulted in more cases of precocious puberty.
Vitamin D
On the other hand, one Italian study which found that the number of consultations for precocious puberty doubled between 2019 and 2021 found that there was no substantial increase in BMI between the two years. This raises the question of what other factor could have caused the increase in consultations related to precocious puberty. One suspected cause is vitamin D deficiency.
During the pandemic, many countries with denser populations limited the amount of time that residents could spend outside. This resulted in a decline in vitamin D levels. Vitamin D deficiency has been shown to be a risk factor for precocious puberty. Additionally, patients receiving hormone therapy in addition to vitamin d supplements had better outcomes than those receiving hormone therapy alone. Patients who also received vitamin D supplements were found to have lower levels of the hormones which stimulate pubertal development and were found to have better height outcomes (short adult height is one of the most common impacts of precocious puberty.)
Psychological Impact
It is also suspected that fears and anxieties around the pandemic may have played a role in the increase in cases of precocious puberty. Many kids around 6 or 7 (the age at which puberty is considered precocious) would have had significant fear around getting sick since they were too young to understand what was going on. Additionally, having their entire life turned upside down at a vulnerable age would have certainly resulted in substantial stress. The activation of stress pathways is a known cause of precocious puberty, since the substantial increase in stress-related hormones can trigger increases in puberty-related hormones. However, the psychological impact that the pandemic had on children has not yet been thoroughly studied enough to confirm this link confidently.
Conclusion
COVID-19 related quarantining resulted in a concerning trend of increased cases of precocious puberty. Though it is unclear why it had this impact, researchers believe that it may be related to increases in BMI and vitamin D deficiency. Both high BMI and vitamin D deficiencies are often identified as causes of precocious puberty. Additionally, it is suspected that the psychological impact of the pandemic could have led to more cases of precocious puberty. However, it may still be too soon to fully assess the effects of the pandemic on precocious puberty.
Further Reading:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9868951/ Assessed and Endorsed by the MedReport Medical Review Board
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