# Impact of the COVID-19 pandemic on the incidence of central precocious puberty: A PRISMA-ScR-COMPLIANT scoping review

## TL;DR

This study found that the incidence of early puberty in girls increased during the COVID-19 pandemic, possibly due to lifestyle and environmental changes.

## Contribution

This is the first scoping review to systematically evaluate the impact of the pandemic on central precocious puberty incidence across multiple countries.

## Key findings

- A 1.3- to 5-fold increase in CPP incidence was observed in girls during the pandemic.
- Boys showed inconsistent CPP trends, with some studies reporting no change or even a decrease.
- Lifestyle factors like increased screen time and sleep disturbances were linked to CPP in girls.

## Abstract

Puberty is a biological maturation process that involves genetic, nutritional,
environmental, ethnic, and lifestyle factors. During the coronavirus 2019
(COVID-19) pandemic, an increase in referrals for central precocious puberty
(CPP) assessment was observed in clinical practice. The aim of this review was
to evaluate the incidence of CPP in different countries before and during the
COVID-19 pandemic. A PRISMA-ScR-compliant scoping review was performed in the
MEDLINE and Embase databases using “puberty” and “COVID-19” as search terms.
Exclusion criteria were an identifiable organic cause of CPP, genetic disorders
or peripheral precocious puberty. The study was registered in OSF. A total of 26
studies with participants from 11 countries were included. Twenty-five studies
found a 1.3- to 5-fold increase in the incidence of CPP in girls. In boys, 4
studies found no significant difference in the number of cases, 3 studies found
a 2.8- to 3.4-fold increase, and 1 study detected a 75% decrease. Twelve studies
reported an increase in the use of electronic devices, sedentary lifestyles,
higher Z-scores for weight and body mass index, increased sleep disturbances,
and a lower age at the onset of puberty. Seven studies found no significant
differences in clinical and laboratory parameters between the pandemic and
pre-pandemic periods. There was an increase in the incidence of precocious
puberty among girls during the COVID-19 pandemic. This finding was not
consistently observed in boys. Increased screen time, reduced physical activity,
psychological stress, changes in diet and sleep habits, and the direct effects
of SARS-CoV-2 may have caused these results.