Pubertal Consequences of Being Born Small for Gestational Age

There is increasing evidence that the in utero environment has a profound effect on later health. Fetal nutritional restriction, usually caused by uteroplacental insufficiency and that manifests with low birth weight for gestational age, is associated with neurocognitive problems, reduced growth potential, and an increased risk of the adult diseases comprising “the metabolic syndrome.” There are also wellcharacterized metabolic abnormalities, the best described being reduced insulin sensitivity in childhood and pathological insulin resistance in later life. A growing body of evidence indicates that early life events can also modify aspects of puberty. Puberty occurs slightly earlier and at a different tempo, with an earlier but attenuated growth spurt resulting in reduced final height. There is also an increased incidence of premature and exaggerated adrenarche, ovarian hyperandrogenism, and polycystic ovary syndrome (PCOS). These conditions are discussed in more detail as are possible underlying etiologies especially insulin resistance and the amplifying effect of obesity.