Early Menarche Linked to Gestational Diabetes Mellitus

Gestational diabetes risk increased by 10% for each earlier year for menarche



Early menarche was associated with a higher likelihood of developing gestational diabetes mellitus (GDM) later in life, according to a new study.

The longitudinal analysis, by Danielle Schoenaker, MSc, and Gita Mishra, PhD, of the University of Queensland in Australia, found that women who had their first period at 11 years of age or earlier had a 51% increased relative risk for developing GDM (95% CI, 1.10 to 2.07) compared with women who had their first period at age 13 or older.

Additionally, the researchers found an adjusted 10% relative risk increase for each year of early menarche before age 11 (95% CI, 1.02-1.18).

Published in the American Journal of Epidemiology, the log-binomial regression analysis was adjusted for risk factors including body mass index, fitness status, and reproductive disorders, among other factors.

"This finding could mean that health professionals will start asking women when they had their first period to identify those at higher risk of gestational diabetes," Schoenaker said in a press release.

Gestational diabetes has been reported as a significant risk factor for type 2 diabetes -- with previous studies showing that up to 50% of those diagnosed with GDM develop type 2 diabetes several years following pregnancy. The researchers hoped to shed light on risk factors for GDM, including the relationship with early menarche.

"Research into this topic is of particular public health importance due to global trends of girls starting their menstrual cycles at a younger age," Mishra explained in the press release. "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."

The research group collected data on women participants in the ongoing Australian Longitudinal Study on Women's Health, which included 4,749 women who completed the baseline survey as well as a minimum of one follow-up study. The baseline survey, administered in 2000, collected participant information on age of menarche, where the mean age was 12.9. A series of four self-reported follow-up surveys were conducted from 2003 to 2012, which obtained information on live births and history of GDM, type 1 diabetes, and type 2 diabetes.

Through the self-reported surveys, women who reported early menarche (age 11 or younger) were also more likely to have been overweight in childhood, have a low physical activity level, and be overweight or obese at baseline, although these associations were adjusted for in the relative risk model for GDM.

Schoenaker and Mishra provided possible explanations for the reported relationship between early menarche and GDM risk: The most plausible, they said, suggests "that a potential pathway may be excessive growth and adiposity in childhood, leading to earlier menarche, which in turn is associated with greater accumulation of adipose tissue that increases the risk of elevated blood glucose levels and insulin resistance, thereby increasing risk of developing GDM."

Still, in addition to BMI, additional pathways beyond adiposity likely play a role, such as higher estrogen levels or lower globulin levels, the researchers wrote.

They suggest that future research is required to further investigate "the role of early-life exposures and weight trajectories" regarding early menarche and the relationship with GDM risk.

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