Early Life Factors Associated With Pubertal Development in Girls: A Cohort Study

Increasing evidence suggests that pubertal development may be influenced by early-life maternal exposures. However, the associations between maternal characteristics across the perinatal period and pubertal development in daughters remain incompletely understood. This study aimed to examine these associations in a prospective cohort of school-aged girls.

A total of 733 girls were recruited from 4 primary schools in Chongqing, China. Participants were aged 7.19-12.80 years at baseline in December 2014 and were followed up every 6 months until June 2022. Pubertal development was assessed using 4 indicators: breast development, pubic hair development, axillary hair development, and menarche. Information on maternal characteristics before, during, and after pregnancy was collected. Cox proportional hazards regression models were used to evaluate associations between early-life maternal factors and the onset of pubertal development.

In multivariable Cox models, girls whose mothers did not report using tocolytic agents during pregnancy had earlier breast development than those whose mothers reported tocolytic agent use (HR = 1.497, 95% CI, 1.024-2.188). Maternal disease during pregnancy was associated with earlier axillary hair development (HR = 1.332, 95% CI, 1.018-1.743). Daughters of mothers aged greater than or equal to 35 years at delivery had earlier axillary hair development than those whose mothers were aged 20-25 years (HR = 1.471, 95% CI, 1.075-2.012). Compared with exclusive breastfeeding during the first 6 months, mixed feeding was associated with earlier menarche (HR = 1.328, 95% CI, 1.010-1.745).

Maternal and perinatal characteristics were associated with the timing of specific pubertal milestones in girls, highlighting the potential importance of early-life health management.