title: Premature birth and age at onset of puberty.
abstract: BACKGROUND
  Premature birth is associated with poor metabolic health in both sexes, potentially via earlier pubertal timing.
  
  
  METHODS
  We examined the associations of gestational age and premature birth (< 37 weeks gestation) with age at onset of puberty (Tanner stage II for breast or genitalia development). We used interval-censored survival analyses in 3963 boys and 3403 girls (93% follow-up) in a population-representative Chinese birth cohort, "Children of 1997," comprising 88% of births in Hong Kong in April and May 1997. We also examined whether the associations varied with sex or with height or body mass index (BMI) at 7 years.
  
  
  RESULTS
  Premature girls reached puberty about 4 months later than girls with ≥ 41 weeks' gestation (time ratio = 1.04 [95% confidence interval = 1.01-1.06]), adjusted for mother' age of menarche, mother's place of birth, and smoking during pregnancy. Gestational age was not associated with onset of puberty in boys (test for interaction by sex, P < 0.01). None of these associations was altered by adjustment for socioeconomic position or varied with childhood height or BMI.
  
  
  CONCLUSIONS
  Premature birth was not related to earlier onset of puberty; instead, premature girls had later onset of puberty. Thus, the association between premature birth and subsequent cardiovascular risk is probably not mediated through the timing of pubertal onset. It is unclear whether onset, duration, or tempo of puberty is more relevant to the detrimental consequences of early puberty. Further studies investigating intrauterine, infant, and childhood influences on the duration and tempo of puberty may help unravel the early origins of cardiovascular diseases.
authors.affiliation: Life course and Lifestyle Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, People's Republic of China.
authors.forename: Lai Ling
authors.initials: LL
authors.lastname: Hui
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Leung
authors.forename: Tai Hing
authors.initials: TH
authors.lastname: Lam
authors.forename: C Mary
authors.initials: CM
authors.lastname: Schooling
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006306:Health Surveys; D006723:Hong Kong; D006801:Humans; D008297:Male; D015233:Models, Statistical; D011247:Pregnancy; D047928:Premature Birth; D011627:Puberty / Q000502:physiology*; D057566:Self Report; D016019:Survival Analysis