Early Puberty Cases in Girls Increased During COVID-19 Pandemic: Study

An 11-year-old girl puts on a mask in Barcelona, Spain, on April 26, 2020. Josep Lago/AFP via Getty Images

The number of girls going through early puberty increased during the COVID-19 pandemic compared with the previous four years, according to a new study published on Aug. 3.

The study, titled “Precocious Puberty Diagnoses Spike, COVID-19 Pandemic, and Body Mass Index: Findings from a Four-Year Study,” was published in the Journal of the Endocrine Society.

As part of the study, researchers in Italy evaluated the incidence rate of abnormal early onset puberty, also known as precocious puberty, before and after the COVID-19 pandemic in Italy compared with the incidence of precocious puberty over the previous four years.

They also assessed a possible relationship between COVID-19 and pandemic-related lifestyle changes.

Puberty usually begins in girls between the ages of 8 and 14, according to the National Library of Medicine, although the exact age at which it starts depends on multiple factors such as family history, health, and nutrition.

In many cases, precocious puberty has no clear cause. Some cases may be attributed to genetic or hormonal issues, such as disorders of the ovaries or a tumor of the hypothalamus, an area of the brain that produces hormones controlling everything from body temperature to mood.

However, precocious puberty is rare, affecting roughly 1 percent of the population in the United States, according to the National Institutes of Health.

For their study, researchers collected anthropometric, biochemical, and radiological parameters from 133 girls between January 2016 and June 2021 to evaluate the incidence of precocious puberty before and after the pandemic.

Study Findings

Using retrospective health records from the Pediatric Endocrine Unit at the University of Genova, they found 72 cases of precocious puberty between January 2016 and March 2020 and 61 cases between March 2020 and June 2021, translating to a 30 percent higher incidence during COVID-19, or four additional cases per month.

In their study, researchers noted that the number of girls referred to pediatric endocrinologists for suspected precocious puberty had increased significantly over the past two years, with such cases reported worldwide.

They noted that this may be due in part to strict lockdowns initiated during the pandemic, which resulted in radical changes in habits and family lifestyles that seriously affected children’s lives.

With parks and gyms closed at the time, this led not only to a reduction in physical activity over a long period but also to reduced social interaction, which the researchers said may have affected children’s physical and mental health.

Because of the strict lockdowns, researchers said, children spent more time watching television or using their mobile devices, which impaired sleep, and consumed less healthful food, the researchers wrote.

The study found that girls diagnosed with precocious puberty during the pandemic tended to have higher body mass index (BMI) scores than girls who weren’t diagnosed (between 1.01 and 1.23 compared with 0.69 and 1.15).

Pupils return to Kelso High School for the first time since the start of the COVID-19 lockdowns in Kelso, Scotland, on Aug. 11, 2020. Jeff J Mitchell/Getty Images

Increased Body Weight and Early Puberty

Those girls diagnosed with early onset puberty also spent an average of nearly two hours per day using electronic devices, and 88.5 percent of them stopped any physical activity, researchers said.

“These data are in line with the positive worldwide trend in weight gain reported before and during the COVID-19 pandemic, and the data reported by others who found a significant increase in BMI during lockdown in Italian girls diagnosed with CPP [central precocious puberty] during the COVID-19 pandemic,” the researchers wrote.

“Our study confirms the rise in precocious puberty diagnoses during COVID-19 and identifies contributing factors such as poor eating and exercise habits, too much screen time, and impaired sleep,“ said study author Dr. Mohamad Maghnie of the University of Genoa and the Giannina Gaslini Institute in Genoa, Italy. ”We found an increase in weight gain among girls diagnosed with precocious puberty during the pandemic, and rapid increase in body weight is associated with advanced pubertal development.”

While researchers noted that lifestyle changes during the pandemic may have led to early onset puberty, they also noted the role that psychological stress and other factors—including the increased use of hand sanitizers—may have played in the increased number of early puberty cases.

“The role of stress, social isolation, increased conflicts between parents, economic status, and the increased use of hand and surface sanitizers represent potentially further interesting hypotheses as to why early puberty is increasing in youth,” Dr. Maghnie said. “The consequence of biological adaptation cannot be entirely ruled out.”

Researchers concluded that further short-term and long-term rigorous epidemiologic and mechanistic studies are needed to fully assess the relationship between the COVID-19 pandemic and early progressive puberty.