P3.M260: Impact of the COVID-19 Pandemic on Precocious Puberty: A Systematic Review

Background: The emergence of SARS-CoV-2 and the subsequent COVID-19 pandemic have extended health concerns beyond respiratory illness to include impacts on various physiological systems, notably the endocrine axis.(2) This has prompted investigations into potential associations between COVID-19 and alterations in pubertal timing, specifically precocious puberty, which poses significant clinical challenges due to its long-term physical and psychological implications. While genetic and environmental factors primarily influence precocious puberty, recent attention has turned to the possible role of infectious agents, including viruses, particularly heightened following the COVID-19 pandemic. By analyzing available evidence our review seeks to clarify the link between COVID-19 infection and precocious puberty, offering valuable insights into underlying mechanisms and clinical implications.

Methods: Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a systematic review on the effect of the COVID-19 pandemic on precocious puberty. A comprehensive PubMed search was performed using keywords such as "precocious puberty," "COVID-19," "SARS-CoV-2," and "children." Data extraction was independently conducted by six reviewers, and the risk of bias assessment was completed.

Results: Of the initial 43 studies assessed for eligibility, seventeen were deemed suitable for inclusion in this review. These studies found a statistically significant association between COVID-19 and precocious puberty onset. Compared to pre-pandemic times, studies reported a three-fold increase in the rate of pubertal progression during lockdowns, with a higher prevalence in females. This trend of increased precocious puberty was observed consistently across diverse countries, including Italy, Spain, USA, India, and China, among others.

Conclusion: Our review identified key lifestyle changes associated with the pandemic that may have influenced pubertal timing. The review identified increased BMI (likely due to dietary changes, reduced physical activity, and screen time), disrupted sleep, Vitamin D deficiency, and psychological stress as potential contributors. Notably, a retrospective study demonstrated a decline in precocious puberty cases after relaxed restrictions suggests a link between pandemic measures and pubertal timing. While the association is clear, the direct effect of COVID-19 infection on puberty remains unclear. Future research should investigate this potential mechanism. This review highlights the multifaceted impact of pandemic-related lifestyle changes and stress on pubertal timing, underlining the need for comprehensive strategies to mitigate these effects on adolescent health.