Earlier Menarche Independently Predicts Gestational Diabetes

Miriam E Tucker

February 05, 2016

The age at which a girl begins to menstruate may independently predict the development of gestational diabetes (GDM) in adulthood, new findings suggest.

Those who began their periods at age 11 or younger were almost 40% more likely to suffer from this pregnancy complication in later years than those who were 14 or older at menarche. Although prepregnancy body mass index (BMI) played a large role in this association, it didn't account for all of it, the analysis of data from the Nurses' Health Study II showed.

"I think age at menarche is very important information for reproductive health history. Ob/gyns should ask their patients about when they started menstruating. This information is not only important for GDM, but also for other women's health outcomes," lead author Liwei Chen, MD, PhD, assistant professor of public health at Clemson University, South Carolina, told Medscape Medical News.

This information can be combined with other test results, as well as "family [and] medical history, current BMI, etc, to identify high-risk individuals," Dr Chen said, adding, "I think ob/gyns should encourage women to have healthy weight before pregnancy, particularly those with early onset of menarche."

The results were published online January 26 in Diabetes Care.

Does Early Menarche Have an Impact on Hormonal Changes Affecting GDM?

In the analysis, 42,109 pregnancies among 27,482 women were examined, and GDM was diagnosed in 1404 pregnancies (including 346 of which were recurrent gestational diabetes); the mean age at menarche was 12.5 years among these women.

Girls with earlier menarche had lower weight at birth, larger body size at ages 5 and 10 years, greater BMI at 18 years, and more weight gain since age 18 years and were more likely to be overweight or obese prior to pregnancy.

After adjustment for age, race/ethnicity, and family history of diabetes, women who experienced menarche at age 11 years or younger had a 39% increased risk for GDM compared with pregnancies among women who began menstruating at age 14 years or older (P for trend < 0.0001).

Further adjustment for the woman's own birth weight and her somatotype at ages 5 and 10 years didn't change the association (P for trend = 0.0003), suggesting that intrauterine and childhood BMI don't confound the association between age at menarche and future GDM, Dr Chen and colleagues note.

The association also appears to be independent of lifestyle factors, including alcohol consumption, smoking status, diet, physical activity, marital status, and oral contraceptive use (P for trend = 0.0003 after adjustment for those).

Additional adjustment for BMI at age 18 years also didn't significantly change the results.

However, the association became statistically insignificant after further adjustment for prepregnancy BMI, which mediated an estimated 42.1% of the effect (P = 0.0007), suggesting that age of menarche remains an important risk factor, but that prepregnancy BMI also plays a major role.

In the paper, Dr Chen and colleagues cite a previous study that found that high plasma estradiol and testosterone and/or low sex-hormone–binding globulin levels were also associated with a higher risk of GDM, independent of adiposity.

"Therefore, it is plausible that age at menarche may be related to GDM risk through its association with hormonal changes. Future studies to investigate the underlying mechanisms are warranted," they conclude.

The Nurses' Health Study II was funded by the National Institutes of Health. For the current study, Dr Chen were supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health. Disclosures for the coauthors are listed in the article.

Diabetes Care. Published online January 26, 2016. Abstract


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