Early puberty rates increased during the COVID-19 pandemic


In a recent study, increased rates of precocious puberty were observed during the COVID-19 pandemic compared to prior years.

Early puberty rates increased during the COVID-19 pandemic  Image Credit: © ibreakstock - © ibreakstock - stock.adobe.com.

Early puberty rates increased during the COVID-19 pandemic Image Credit: © ibreakstock - © ibreakstock - stock.adobe.com.

According to a recent study published in the Journal of the Endocrine Society, the rate of girls starting puberty early increased during the COVID-19 pandemic.

The United States underwent a total lockdown in early 2020 because of the COVID-19 pandemic, with environments such as parks and gyms remaining closed until May 2021. The pandemic had significant effects on mental health, leading to unhealthy habits such as increased screen time, unhealthy food consumption, and impaired sleep.

Examining a similar timeframe, significantly increased rates of pediatric endocrinologist visits for suspected precocious puberty (PP) have been observed over the past 2 years. Investigators conducted a study to evaluate the incidence of idiopathic central precocious puberty before and after the COVID-19 pandemic compared to PP incidence during the prior 4 years.

Data was obtained from the health records of girls referred to a tertiary-level academic center for suspected PP between January 2016 and June 2021. Eligibility criteria included having breast development Tanner stage of 2 or greater when aged under 8 years and advanced bone age by at least 1 year, basal serum LH over 0.3 U/L, peak LH over 5 U/L after LH releasing hormone test, or negative brain magnetic resonance imaging.

Exclusion criteria included having premature thelarche, genetic syndrome, brain tumor, other preexisting condition, peripheral precocious puberty, or isolated premature thelarche before 2 years of age.

Anamnestic data collected included family history of PP, age at thelarche, sport activity, ethnicity, COVID-19 infection in patients or parents in prior months, and changes in screen viewing history and eating habits. Clinical data was also gathered, such as weight, height, SD score, body mass index, and pubertal Tanner stage.

The first group consisted of girls diagnosed with rapidly progressive idiopathic central precocious puberty (RP-ICPP) from January 2016 to February 2020, while the second group consisted of girls diagnosed with RP-ICPP from March 2020 to June 2021. Breast inspection and palpation were used to determine pubertal maturation.

There were 289 girls with breast development before the age of 8 years included in the analysis, 175 in group 1 and 114 in group 2. Of these, 72 girls were diagnosed with RP-ICPP in group 1 and 61 in group 2. These were measured as rates of 1.44 cases per month in group 1 and 3.8 cases per month in group 2.

The incidence of RP-ICPP was increased in group 2 compared to group 1, at a rate of 53.5% vs 41.1%. The number of girls aged under 8 years diagnosed with RP-ICPP in group 2 increased with age, but the number of girls aged over 8 years diagnosed with RP-ICPP was higher in group 1.

Twenty-two percent of patients in group 1 had a family history of early menarche, compared to 19% in group 2. Of patients with RP-ICPP, 20% had non-European ethnicity. While the mean age of pubertal onset did not significantly differ between both groups, the age at RP-ICPP diagnosis was 7.61 ± 0.94 years vs 7.96 ± 0.71 years for groups 1 and 2, respectively.

These results indicated a significant increase in rapidly progressive PP during the COVID-19 pandemic. Investigators recommended further studies be conducted to determine how pubertal development is impacted by screen time, reduction in physical activity, and change in sleep patterns.


Fava D, Pepino C, Tosto V. Precocious puberty diagnoses spike, COVID-19 pandemic, and body mass index: findings from a 4-year study. Journal of the Endocrine Society. 2023:7(9). doi:10.1210/jendso/bvad094

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