New Delhi: Paediatricians and gynaecologists from across India are reporting a rise in precocious puberty — before the age of eight for girls and nine for boys — especially after the COVID-19 pandemic.
Now, the National Institute for Research in Reproductive and Child Health (NIRRCH) in Mumbai, under the Indian Council of Medical Research (ICMR), is planning the first national-level survey to assess the degree of prevalence, ThePrint has learnt.
The exercise could kick off later this year.
Rate of early puberty rising in India? ICMR plans nationwide project to find answers“We are in the process of designing the study and it will be a multi-centric project — a nationally representative survey — which could give us a clearer picture of the true burden and pattern of the condition,” Dr Antara A. Banerjee, a scientist at NIRRCH-ICMR, told ThePrint.
Banerjee, who is associated with the project, said it might be difficult to assess specifically whether India is seeing a rise in precocious puberty after Covid, since no comprehensive data is available from earlier, but added that anecdotal evidence from clinicians supported the theory.
“Many doctors do report seeing more young kids getting diagnosed with precocious puberty,” said Banerjee, whose primary area of research is puberty.
She added that it was possible that cases of precocious puberty rose during this period.
Puberty is when an adolescent reaches sexual maturity and becomes capable of reproduction — typically starting between the ages of eight and 13 in females and nine and 14 in males. But over the past few decades, this essential highlight of a person’s growth trajectory has been brought forward, leaving clinicians and scientists worried.
Gauged by the appearance of secondary sex characteristics such as breasts, public hair, and the onset of menstruation, precocious puberty is detected most often — up to ten times more likely — detected in girls because the characteristics are more visible in them.
In boys, the condition can be characterised by enlarged testicles and penis, deepening of the voice and facial hair, mainly on the upper lip.
Banerjee said that sometimes, parents do not appreciate the challenge the condition poses, even though it can have lasting repercussions on a child’s mental and physical development, apart from several endocrinological disorders later in life, mainly in girls.
According to Dr Karthika Reddy Byreddy, consultant obstetrician and gynaecologist with Yashoda Hospitals in Hyderabad, common factors leading to early puberty could include obesity, coupled with lack of sleep, stress and anxiety, and exposure to hormone-disrupting chemicals, among others.
Early puberty not only impacts the physical development of children, leading to premature bone maturation and shorter adult height, but also engenders emotional and psychological challenges such as low self-esteem and anxiety, said Dr Meghna Chawla, a consultant paediatric endocrinologist at Ruby Hall Clinic in Pune.
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Growing concern
The average age of puberty’s onset — ranging between eight and 13 years for girls in the world over — has been dropping by about three months every decade over the past 40 years, according to an analysis of global data in 2020.
This is true for India too, says Banerjee.
From India though, empirical evidence on true prevalence of precocious puberty is limited and scant. A 2017 cross-sectional study among girls in the age group of 11 to 15 years in two schools in Kollam, Kerala, put the prevalence at a significant 10.4 percent.
But Banerjee said this seemed “too high”. The global prevalence of precocious puberty, she said, was about one in 4,000 kids.
However, clinicians have reported a rise in cases. Dr Priyanka Suhag, a consultant at the Department of Obstetrics and Gynaecology at Delhi’s C.K. Birla Hospital, said she sees one or two such patients nearly every day in her outpatient department.
“Early puberty is a growing concern for several reasons as it totally disrupts the normal development of kids,” she said.
Byreddy said untreated precocious puberty could lead to short stature and can also cause significant emotional and behavioural issues.
She said a few studies have shown that children experiencing precocious puberty are likely to engage in high-risk behaviours such as substance abuse, social isolation and truancy.
“They also have a lot of peer pressure and self-image concerns. However, most of these problems are resolved by early adulthood. More studies are needed to validate the psychological consequences of the condition,” the clinician added.
Chawla insisted that signs such as breast development and pubic hair growth before the age of eight, rapid height growth, changes in body odour, and menstruation onset before the age of 10 warranted attention.
Challenges in diagnosis, treatment
Precocious puberty is of two types: central or gonadotropin-dependent precocious puberty, where the child’s brain releases sex hormones or androgens too early; and peripheral precocious puberty or gonadotropin-independent precocious puberty, where the condition is triggered by the child’s sex organs.
Most of the reported cases are of the first type. The gold standard to identify central precocious puberty is repeated blood sampling at several points in time to measure the levels of two sex hormones — luteinizing hormone (LH) and follicle-stimulating hormone (FSH) — as part of the gonadotropin-releasing hormone (GnRH) stimulation test.
The test is conducted to see how well the pituitary gland — which controls and regulates the functioning of several other endocrine glands — works. The blood samples taken over the next several hours then show how hormones in the child’s body react to GnRH.
In children with central precocious puberty, GnRH will cause LH and FSH to rise. For those detected with the condition, the treatment can be carried out through puberty blockers till 11 to 12 years of age.
But, ICMR scientist Banerjee explained, many cases of early puberty can be of “incomplete precocious puberty” where, while some secondary sex characteristics may appear in an affected child, it will not go on to develop into full puberty such as menarche or the onset of menstruation in girls.
“But the challenge with the current diagnostic test is that we don’t have a known cut-off GnRH range that can be administered during the test to predict which case will stay an incomplete precocious puberty and which one will progress further. Our effort is to develop that reference range clearly, which will help paediatricians and gynaecologists in treating their patients in a better way,” Banerjee said.
(Edited by Tikli Basu)
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