Clinical Report: Increased Precocious Puberty Incidence During COVID-19 Pandemic
Overview
This meta-analysis of 32 studies involving 24,200 children found that the COVID-19 pandemic was associated with nearly double the odds of precocious puberty (PP) among children referred for suspected cases. Notably, age at presentation was lower during the pandemic, while body mass index (BMI) standard deviation scores did not differ significantly between periods.
Background
Precocious puberty (PP), defined as puberty onset before age 8 in girls and 9 in boys, primarily involves central PP due to hypothalamic–pituitary–gonadal axis activation. PP incidence has been rising globally over the past two decades, with significant health and psychosocial consequences if untreated. Adiposity and environmental factors, including sleep patterns and childhood adversities, contribute to PP risk. The COVID-19 pandemic introduced lifestyle changes and healthcare access challenges that may have influenced PP incidence and presentation.
Data Highlights
Parameter
Pre-pandemic
During Pandemic
Effect Measure
Number of Studies
32
Participants
24,200
Odds Ratio for PP
Reference
1.96 (95% CI, 1.56-2.47)
P < .001
BMI SDS
Not significantly different
Not significantly different
NS
Age at Presentation
Higher
Lower
Significant decrease
Heterogeneity (I2)
54%
Key Findings
The COVID-19 pandemic nearly doubled the odds of PP diagnosis among children referred for suspected cases (OR = 1.96; 95% CI, 1.56-2.47).
Age at presentation for PP was significantly lower during the pandemic compared to the prepandemic period.
BMI standard deviation scores did not differ significantly between the two periods, suggesting adiposity was not a primary driver of increased PP incidence during the pandemic.
PP incidence increased more rapidly during the pandemic than in previous years, indicating a temporal association with COVID-19-related factors.
Sensitivity analyses confirmed the robustness of these findings despite moderate heterogeneity (I2 = 54%).
Clinical Implications
Clinicians should be aware of the increased incidence and earlier presentation of precocious puberty during and following the COVID-19 pandemic. While BMI did not significantly change, other pandemic-related factors such as lifestyle changes and delayed healthcare access may contribute to this trend. Early recognition and timely management remain essential to mitigate long-term adverse outcomes associated with PP.
Conclusion
The COVID-19 pandemic is associated with a significant increase in precocious puberty incidence and earlier age at presentation among children. These findings highlight the need for heightened clinical vigilance and further research into underlying mechanisms.
References
Systematic Review and Meta-Analysis, 2023 -- Comparative Analysis of Precocious Puberty Incidence Before and During the COVID-19 Pandemic
