Exposure to Diabetes in Utero Is Associated with Earlier Pubertal Timing and Faster Pubertal Growth in the Offspring: The EPOCH Study

J Pediatr. 2019 Mar:206:105-112. doi: 10.1016/j.jpeds.2018.10.053. Epub 2018 Dec 6.


Objective: To examine the associations of in utero exposure to maternal diabetes with surrogate measures of offspring pubertal timing (age at peak height velocity [APHV]) and speed of pubertal growth (peak height velocity [PHV]).

Study design: Data from 77 exposed and 340 unexposed youth followed from age 2 to 19 years (51% non-Hispanic white, 50% female) were analyzed using the Exploring Perinatal Outcomes among Children study, a historical prospective cohort. Maternal diabetes status was collected from obstetric records, and child heights from 2 years to current age from pediatric records. Other covariates were collected during research visits. The superimposition by translation and rotation method, using height measurements (4-52 per participant), modeled APHV and PHV. Accelerated failure time analyses were used to test whether exposure to maternal diabetes was associated with younger APHV and faster PHV.

Results: Adjusting for child's sex, race/ethnicity, and socioeconomic status, median APHV was reached ~3 months earlier in youth exposed to maternal diabetes compared with unexposed youth (P < .03). Youth exposed to maternal diabetes had a faster PHV than unexposed youth: exposed girls had 10.5% greater median PHV compared with unexposed girls and exposed boys had a 4.0% greater median PHV compared with unexposed boys (P < .001 for exposure by sex interaction).

Conclusions: Our findings provide evidence that exposure to maternal diabetes in utero is associated with earlier pubertal timing and faster pubertal growth. Whether earlier puberty or faster speed of pubertal growth mediates the association between maternal diabetes exposure and later chronic disease risk remains to be studied.

Keywords: SITAR; age at peak height velocity; lifecourse epidemiology; peak height velocity; perinatal exposure.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Anthropometry
  • Body Height
  • Body Mass Index
  • Child
  • Child, Preschool
  • Colorado / epidemiology
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / physiopathology*
  • Diabetes, Gestational / physiopathology*
  • Female
  • Humans
  • Male
  • Menarche
  • Pregnancy
  • Pregnancy in Diabetics / physiopathology*
  • Prenatal Exposure Delayed Effects*
  • Prospective Studies
  • Puberty
  • Puberty, Precocious / etiology*
  • Sexual Maturation
  • Social Class
  • Young Adult