Early-Onset Menarche Increases Gestational Diabetes Risk

Pam Harrison

March 10, 2017

Girls who have their first period at 11 years of age or younger are at a significantly greater risk of developing gestational diabetes during pregnancy than their counterparts who have their first period at the age of 13, a population-based cohort study from Australia indicates.

The results were published online March 5 in the American Journal of Epidemiology.

"Gestational diabetes is an increasingly common complication of pregnancy, and it has long-lasting health consequences for both mothers and their children," study authors Danielle Schoenaker and Gita Mishra, PhD, both from the University of Queensland, in Herston, Australia, write.

"[And we found that] compared with women who had their first menstruation at age 13 years, women with menarche at or before age 11 years had a 51% higher risk of gestational diabetes after controlling for early-life, reproductive, and lifestyle factors and BMI," they add.

"Identification of women at risk of gestational diabetes at an early life stage may allow early health monitoring and intervention," they note.

The findings add to prior inconsistent results on this topic, they add — younger age at menarche was associated with higher risk of gestational diabetes in the Nurses' Health Study II, as reported by Medscape a year ago, but not in the Omega Cohort Study.

Each Year of Earlier Menarche Ups Risk of Gestational Diabetes by 10%

The new data were derived from the Australian Longitudinal Study of Women's Health — involving individuals born between 1973 and 1978 — for which Dr Mishra is the director.

A series of sequential surveys were done over time using the same cohort. For the current analysis, investigators analyzed age at menarche reported in the second survey, in 2000, when participants were between 22 and 27 years of age. The mean age at menarche was 12.9 years.

In total, Ms Schoenaker and Dr Mishra analyzed findings from 4749 women who participated in the study between 2000 and 2012.

At 12 years of follow-up, a first diagnosis of gestational diabetes was reported by 7.5% of the cohort. The investigators based the incidence of gestational diabetes on self-reports of physician-diagnosed gestational diabetes that occurred between 2000 and 2012.

On crude analysis, females who had their first period at the age of 11 or younger had a 68% higher risk of subsequently being diagnosed with gestational diabetes than those who had their first period at 13 years.

After taking into account a number of risk factors for gestational diabetes, including polycystic ovary syndrome, nulliparity, and level of physical activity, researchers found that this risk dropped slightly and was further, although still only modestly, attenuated by adjustment for BMI.

Indeed, "for each year of earlier menarche, risk of developing gestational diabetes was 10% higher...after adjustment for all relevant…risk factors," Ms Schoenaker and Dr Mishra note.

Ask About First Period to Identify Risk for Gestational Diabetes

Hormonal changes could explain the link found between timing of menarche onset and risk of gestational diabetes, which appeared independent of BMI, they continue.

But in the Nurses' Health Study II, the association between younger age at menarche and risk of gestational diabetes was no longer significant after adjustment for adult BMI, the researchers point out.

And they note that girls who begin their periods earlier are at higher risk of overweight or obesity. Since obesity is a strong risk factor for the development of gestational diabetes, "BMI may lie on the causal pathway of this association," they opine.

"A large proportion of women who develop diabetes during pregnancy are overweight or obese, and encouraging those with an early start of puberty to control their weight before pregnancy may help to lower their risk of gestational diabetes," Ms Schoenaker said in a University of Queensland statement.

"[And our findings] could mean that health professionals will start asking women when they had their first period to identify those at higher risk of gestational diabetes," she added.

The authors had no relevant financial relationships.

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Am J Epidemiol . Published online March 5, 2017. Abstract


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