Determining the prevalence and risk factors associated with precocious puberty among pre-pubertal girls in Mumbai

Background

Precocious puberty (PP) is defined as the appearance of secondary sex characteristics before age 8 years in girls. It may manifest with either development of all the secondary sexual features (progressive PP) or as isolated premature thelarche, adrenarche or menarche. Environmental variables, weight, foetal nutrition, childhood dietary habits, physical activity, psychological factors, genetic factors and/or endocrine disrupting chemicals are known to affect timing of puberty.

There has been ethnic and geographical variation in timing of puberty globally. It is seen that very few prospective studies have been undertaken globally to understand prevalence of PP and majority studies have focussed only retrospective assessment on basis of early menarche. There is lack of information on prevalence, associated factors, EDCs as risk factors of early puberty from India.  Recent increase in incidence of childhood obesity and precocity during pandemic times has been reported in Indian newspapers. Hence, there is an urgent need of evidence on magnitude and risk factors associated with precocious puberty in Indian setting. Therefore, the present study is planned to determine the prevalence and risk factors associated with Precocious puberty among   pre-pubertal girls in Mumbai

Novelty

There has been ethnic and geographical variation in timing of puberty globally. However, majority studies have focussed only retrospective assessment of precocious puberty on basis of early menarche, especially with respect to studies in India. Majority studies have focussed on visual grading of breast stages. There is limited information on pubertal staging to document a trend to earlier maturation. Also, there is lack of information on prevalence, associated factors and determinants of early puberty from India  It is crucial to    puberty timely to initiate treatment as intervention is  not possible at later stage.

There is an urgent need of evidence on magnitude and risk factors associated with precocious puberty in Indian setting

Objectives

Primary Objective

To determine the prevalence of precocious puberty (Premature thelarche, adrenarche and menarche) among girls in the age group of 6-9 years

Secondary Objective

1.   To evaluate the risk factors associated with precocious puberty among girls in the age group of 6-9 years

2. To assess the knowledge about pubertal changes, health seeking behavior and attitude towards imparting pubertal information to girls among mothers

3.   To evaluate association of precocious puberty and exposure of endocrine disrupting chemicals

 Methods

A prospective study will be carried out at community Clinic over a period of 2 years. Approximately 1000 girls in the age group of 6 -9 years from the schools in the vicinity with will be included.

Girls with diagnosis of early puberty will undergo detail History and Baseline hormonal investigations, USG, Bone age will also be recorded.  Baseline values of Kisspeptin, Neurokinin B, Neuropeptide Y and MKRN3 protein will be estimated. The levels will be repeated at the end of treatment to evaluate therapeutic relevance.

Expected Outcome

The study will help us to understand the determinants of ICPP and incomplete puberty and explore Clinical and therapeutic relevance.