Pubertal development and sexuality in female adolescents born preterm: a review of the literature

Introduction: Premature infants, especially very low birth weight infants, and fetal growth restriction are a challenge for healthcare professionals alike owing to the consequences of these conditions. Objective: To provide information for gynecologists, pediatricians and neonatologists to identify correct outcome expectations to help them plan their preventive and therapeutic actions. Searches were made on the MEDLINE database. Results: According to several follow-up studies, there is an increasing evidence for a link between early life exposures (prenatal and postnatal) and long-term outcomes. An adverse in utero environment will induce fetal reprogramming of neuroendocrine axes with permanent alterations of the physiology and metabolism of various body structures and functioning of neuroendocrine axes in later life, leading to a variety of different conditions, such as persistence of neurodevelopmental disability, changes in growth pattern, in body metabolism, in pubertal development, lower educational achievement and even psychological disturbances with possible alterations of sexual behavior in female adolescents and young adults. In addition, short-term transitory consequences can be also present, such as anomalies in genital appearance. Conclusions: Outcome studies on the impact that prematurity, low birth weight and intrauterine growth restriction have on pubertal development, sexuality and fertility are still scarce. Long-term outcomes of small for gestational age or preterm adolescents are complex and multifactorial, with interactions between genetic and environmental influences involving different pathways of adaptive responses during crucial phases of prenatal growth.