Associations between Maternal Pregravid Obesity and Gestational Diabetes and the Timing of Pubarche in Daughters

Ai Kubo, Assiamira Ferrara, Cecile A. Laurent, Gayle C. Windham, Louise C. Greenspan, Julianna Deardorff, Robert A. Hiatt, Charles P. Quesenberry, Lawrence H. Kushi

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20 Scopus citations


We investigated whether in utero exposure to maternal pregravid obesity and/or gestational diabetes mellitus (GDM) was associated with early puberty in girls. We used data from a longitudinal study of 421 mother-daughter pairs enrolled in an integrated health services organization, Kaiser Permanente Northern California (2005-2012). Girls aged 6-8 years were followed annually through ages 12-14 years. Onset of puberty was assessed using study clinic-based Tanner staging. We examined associations of self-reported pregravid obesity and maternal GDM with timing of the daughter's transition to pubertal maturation stage 2 or above for development of breasts and pubic hair, using accelerated failure time regression models with interval censoring to estimate time ratios and hazard ratios and corresponding 95% confidence intervals. Maternal obesity (pregravid body mass index (BMI; weight (kg)/height (m)2) ≥30) was associated with a daughter's earlier transition to breast and pubic hair stage 2+ in comparison with girls whose mothers had pregravid BMI <25. These associations were attenuated and not statistically significant after adjustment for covariates. Girls whose mothers had both pregravid BMI ≥25 and GDM were at higher risk of an earlier transition to pubic hair stage 2+ than those whose mothers had neither condition (adjusted time ratio = 0.89, 95% confidence interval: 0.83, 0.96; hazard ratio = 2.97, 95% confidence interval: 1.52, 5.83). These findings suggest that exposure to maternal obesity and hyperglycemia places girls at higher risk of earlier pubarche.

Original languageEnglish (US)
Pages (from-to)7-14
Number of pages8
JournalAmerican Journal of Epidemiology
Issue number1
StatePublished - Jul 1 2016
Externally publishedYes


  • gestational diabetes
  • intergenerational disease transmission
  • life-course epidemiology
  • obesity
  • prenatal exposure delayed effects
  • pubarche
  • puberty
  • thelarche

ASJC Scopus subject areas

  • Epidemiology


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