Our study adds to prior evidence that early-life exposures influence age at menarche and is the first to report an association with maternal pre-pregnancy diabetes. Besides replication of findings within other study populations, future studies should examine a broader set of pubertal changes beyond age at menarche. Greater understanding of the possible biologic mechanisms that could explain our findings is also an important area for future research. Furthermore, our findings have methodological implications, as early-life factors may confound some of the associations between age at menarche and hormonally-dependent adult outcomes such as breast cancer.
