Perinatal & Pediatric
Adverse childhood experiences and timing of pubertal onset in a racially and ethnically diverse cohort of adolescents in Northern California Ai Kubo* Sara Aghaee Julia Acker Julianna Deardorff Ai Kubo
Earlier puberty is associated with mental and physical health conditions throughout the life course. Girls who experience psychosocial stress appear to develop earlier than their peers. Adverse childhood experiences (ACEs) increase the risks of numerous chronic conditions. Previous studies on childhood adversity and puberty were limited by small samples, limited puberty data (i.e., age at menarche only), exclusion of boys, and racially/ethnically homogeneous samples.
We used a diverse cohort of 21,728 boys and 19,319 girls born at a Kaiser Permanente Northern California facility from 2003-11. Pubertal outcomes were determined using pediatrician-assessed Tanner stages during routine well-child visits. Girls are assessed for breast development (thelarche) and their first menses (menarche); boys are assessed for testicular enlargement (gonadarche); and both are assessed for pubic hair development (pubarche). Exposure is the highest reported ACEs score, measured using the standard 10-item questionnaire which has been administered during pediatric visits since 2021. We used adjusted Weibull and logistic regression models.
There were clear dose-effect relationships between ACEs and earlier pubertal timing in girls (p<0.01). Associations were greatest among girls with ≥7 ACEs (thelarche: adjusted HR=1.28, 95% CI=1.01-1.61; pubarche: HR=1.25, 95% CI=1.00-1.57; menarche (ref= ≥12 years): adjusted OR= 1.73, 95% CI=1.17-1.54), compared to those with no ACEs. There were significant interactions between ACEs and race/ethnicity in the thelarche models, with the strongest associations found in White and Black girls. There were no associations among boys.
These results suggest that girls’ pubertal timing is more vulnerable than boys to exposure to early life adversities. Because early puberty is linked to numerous adverse outcomes over the life course, screening for ACEs and intervening with high-risk children early will help improve adolescent mental health and reduce disparities.