1. In a prospective cohort study of over 40 000 pregnancies from over 27 000 women, earlier onset of menarche was associated with an increased risk of gestational diabetes mellitus (GDM).
Evidence Rating Level: 2 (Good)
Study Rundown: GDM is one of the most common pregnancy-related complications in the United States, affecting approximately 2-7% of all pregnancies. To date, there has been a paucity of data on the association between the timing of pubertal onset and GDM. The purpose of this prospective cohort study was to examine the association between age at menarche and the risk of developing GDM.
This study prospectively followed the health outcomes of over 40 000 eligible pregnancies from over 27 000 women. At the conclusion of the trial, earlier onset of menarche was found to be significantly associated with the development of GDM. This association was independent of other known GDM risk factors, including age, parity, and family history of diabetes. The results of this study support the hypothesis that early menarche is a risk factor for the development of GDM. However, this association is weakened after adjustments for pre-pregnancy BMI, suggesting a common association between GDM and early hormonal changes. Additional studies are needed to clarify this specific association.
In-Depth [prospective cohort]: The study followed the outcomes of 42 109 pregnancies from 27 482 women as part of The Nurses’ Health Study II, a large prospective database in the United State. GDM events were identified based on patient self-reported information. The age at menarche was grouped categorically as less than 11 years, 12 years, 13 years, and greater than 14 years of age. At the conclusion of the study, the adjusted relative risk for GDM for women with onset of menarche at 11 years, 12 years, and 13 years of age were 1.34 (95% CI: 1.14 to 1.58), 1.13 (95% CI: 0.97 to 1.31), and 1.11 (95% CI: 0.95 to 1.29), respectively. Women with menarche prior to the age of 11 years of age had a 39% increased risk of GDM (RR: 1.39; 95% CI 1.19 to 1.63) compared to those with onset of menarche at 14 years of age. After adjustments for known risk factors of GDM, pre-pregnancy BMI was found to be a significant mediator of the association between age of menarche and GDM.
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