Prenatal Testosterone Levels Associated with Childhood Physical Activity and Muscle Strength

Emerging research presented at the upcoming Joint Congress of the European Society of Paediatric Endocrinology (ESPE) and the European Society of Endocrinology (ESE) in Copenhagen sheds new light on the intricate influence of maternal hormone levels during pregnancy on the physical development and activity of offspring. This pioneering study focuses on the relationship between maternal polycystic ovary syndrome (PCOS), prenatal testosterone exposure, and subsequent physical activity and muscle strength outcomes in children at seven years of age. The findings reveal a sexually dimorphic pattern that underscores the complex interplay between prenatal endocrine environments and childhood physiology.

Testosterone, the primary androgen hormone, is well-known for its critical role in male fetal development, influencing not only reproductive structures but also neurodevelopmental pathways and musculoskeletal growth. During gestation, circulating testosterone levels rise in all pregnant women, irrespective of the sex of the fetus. However, women diagnosed with PCOS—an endocrine disorder characterized by ovarian dysfunction leading to hyperandrogenism—typically exhibit elevated maternal testosterone even further. As PCOS is prevalent in up to 13% of women of reproductive age, understanding its implications for offspring development is a matter of growing medical and public health interest.

The research team, hailing from Odense University Hospital and the University of Southern Denmark, leveraged the extensive longitudinal Odense Child Cohort, which tracks the health parameters of children from birth through adolescence. They analyzed third-trimester testosterone concentrations in 695 pregnant women, stratified by PCOS status, correlating these hormonal profiles with objective assessments of their children’s physical activity levels and muscular strength at the age of seven. Utilizing accelerometers for continuous seven-day monitoring, researchers bypassed the subjective biases often encountered with questionnaire-based physical activity assessments, providing robust, quantifiable data across both sexes.

Their analyses revealed that boys born to mothers with PCOS demonstrated notably reduced physical activity levels during weekends, a critical period characterized by discretionary movement choices outside structured weekday routines. This specific decrease was independent of confounding factors such as birth weight and maternal pre-pregnancy body mass index (BMI), suggesting a direct association with prenatal hormonal milieu rather than postnatal environmental or genetic influences. Reduced voluntary physical activity during weekends in these boys is clinically significant, as it may predispose them to future metabolic disorders, including obesity and cardiovascular disease (CVD).

Conversely, the study elucidated a distinct pattern for girls exposed to elevated maternal testosterone. While no significant changes in their physical activity levels were observed, these girls exhibited a measurable reduction in muscle strength at age seven. Muscle strength during childhood is intricately linked to long-term musculoskeletal health, physical function, and metabolic regulation, indicating that prenatal androgen exposure may exert divergent effects across sexes, potentially mediated by sex-specific programming mechanisms during neuro-muscular development.

Prenatal testosterone exposure’s role extends beyond reproductive organ differentiation, affecting neurological circuits responsible for motor control, energy expenditure, and perhaps motivational states related to physical activity engagement. Elevated maternal testosterone in PCOS pregnancies may alter the developmental trajectory of these systems differently in male and female offspring, mirroring the dimorphic outcomes noted in physical activity and muscle strength metrics. This bifurcation highlights the nuanced nature of androgenic influence on offspring, demanding hypothesis-driven exploration of underlying molecular and epigenetic pathways.

Importantly, this study builds on previous work from the same research group, which documented diminished grip strength among five-year-olds with higher prenatal testosterone exposure and an association between this gestational hormone exposure and increased adiposity in seven-year-old boys. The confluence of reduced muscle strength and lower physical activity could synergistically contribute to adverse cardiometabolic profiles, accentuating the potential for long-lasting health sequelae rooted in prenatal endocrine environments. By integrating biomechanical and behavioral data, these findings offer a comprehensive view of developmental programming.

A novel aspect of this research is its stratification of outcomes by sex and objective measurement of physical activity. Such methodological advances enable a more precise characterization of early-life influences on offspring health trajectories, allowing health professionals to develop targeted interventions. The weekend-specific physical activity reduction in boys suggests that behavioral factors and lifestyle choices during discretionary periods may be crucial intervention targets to mitigate downstream metabolic risks in this population.

The authors emphasize that although PCOS is a condition inherently affecting females, its metabolic repercussions extend transgenerationally, influencing male offspring’s propensity for activity and disease vulnerability. This revelation challenges traditional conceptualizations of PCOS as solely a female disorder and highlights the need for a family-centered approach in managing and counseling women affected by PCOS during and following pregnancy.

Looking ahead, the research team plans to extend follow-up assessments into adolescence and beyond, leveraging the longitudinal framework of the Odense Child Cohort. Such longitudinal data will be instrumental in determining whether the observed reductions in physical activity and muscle strength persist or evolve during critical developmental windows. Moreover, longitudinal analyses will allow exploration of associations with emergent metabolic outcomes including obesity, hypertension, and type 2 diabetes, further elucidating the long-term health implications of prenatal hormonal exposures.

This sophisticated research underscores the broader realm of developmental origins of health and disease (DOHaD), suggesting that prenatal exposures might predispose individuals to lifestyle behaviors and physical capabilities that operate as early determinants of chronic disease risk. By elucidating how maternal endocrine profiles influence offspring phenotypes, particularly in relation to modifiable behaviors such as physical activity, this work opens pathways for early preventative strategies aimed at improving lifetime metabolic health.

In sum, these findings provide compelling evidence that maternal PCOS and heightened third-trimester testosterone levels intricately affect physical activity and muscle strength development in children, with clear distinctions between boys and girls. The sex-specific modulation of these traits by prenatal androgenic milieu heralds new scientific inquiry into the mechanisms governing developmental programming and their public health ramifications. Enhanced understanding in this area holds the promise of informing clinical practice, shaping prenatal care protocols, and ultimately reducing the burden of cardiometabolic diseases programmed in utero.

Subject of Research: The impact of maternal polycystic ovary syndrome (PCOS) and prenatal testosterone exposure on the physical activity and muscle strength of offspring at age seven.

Article Title: Maternal PCOS and Prenatal Testosterone Exposure Differentially Affect Childhood Physical Activity and Muscle Strength: Insights from the Odense Child Cohort

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Image Credits: European Society of Endocrinology

Keywords: Testosterone, Pregnancy, Developmental timing, Endocrinology, Hormones, Physical exercise, Muscles, Children, Diseases and disorders

Tags: childhood physical activityendocrine disorders in pregnancyfetal development and neurodevelopmentmaternal health and offspring developmentmaternal hormone levelsmuscle strength developmentPCOS and child healthpediatric endocrinology researchpolycystic ovary syndrome impactprenatal testosterone exposuresexually dimorphic outcomestestosterone and musculoskeletal growth