Health-Related Quality of Life in Short Children Born Small for Gestational Age: Effects of Growth Hormone Treatment and Postponement of Puberty

Abstract

Aims: To investigate health-related quality of life (HRQoL) in short children born small for gestational age (SGA) during growth hormone (GH) treatment and additional postponement of puberty by gonadotropin-releasing hormone analogue (GnRHa). Methods: HRQoL was studied longitudinally during 2 years of treatment in 97 short SGA children (mean age 11.6 years at start). The children were divided into three groups: prepubertal GH-treated (prep-GH) children, pubertal GH-treated (pub-GH) children, and pubertal GH-treated children with additional GnRHa treatment (pub-GH/GnRHa). HRQoL was measured by generic (TACQOL) and short stature-specific (TACQOL-S) questionnaires. Results: The TACQOL-S showed that prep-GH children experienced significant HRQoL improvement on the subscales ‘contact with adults’, ‘body image’ and ‘vitality’, and pub-GH/GnRHa children on the subscales ‘contact with adults’, ‘contact with peers’ and ‘physical abilities’. Parents of prep-GH and pub-GH/GnRHa children reported significant HRQoL improvement on most TACQOL-S scales, whereas HRQoL improvement in pub-GH children reached significance for ‘future prospects’ only. The HRQoL gain was similar in the three groups, also after correction for confounders. The generic questionnaire TACQOL did not reveal any changes. Conclusions: HRQoL improved in prepubertal and pubertal short SGA children during GH treatment. Additional GnRHa treatment had no adverse effect on the HRQoL gain. Disorder-specific questionnaires were particularly appropriate to evaluate HRQoL in children treated for short stature.

Quality of Life in Children and Adolescents with Growth Hormone Deficiency: Association with Growth Hormone Treatment

“…In concordance with our findings, previous studies showed a better QoL in GH-treated children compared to untreated children with short stature with a focus on behavioral functioning [11,14,27,28]. Lem et al [29 ]reported an increase of health-related QoL also in short children small for gestational age treated with GH. In contrast, only one study found that treatment with GH did not improve QoL in idiopathic short children [30].…”

Bone Mineral Density and Body Composition in Short Children Born SGA during Growth Hormone and Gonadotropin Releasing Hormone Analog Treatment

“…In case of a poor AH prognosis at the start of puberty, 2 yr of GnRHa in addition to GH treatment can improve AH without an adverse effect on health-related quality of life (20,43) and, as shown here, without adverse effects on BMD or body composition.…”

“…The inclusion and exclusion criteria of the Dutch SGA study have been described before (20). Briefly, children were included when they met the following criteria: 1) birth length and/or birth weight SD score (SDS) for gestational age less than Ϫ2.0 (21); 2) chronological age of 8 yr or older; 3) prepubertal stage (Tanner stage 1) or early pubertal stage [breast stage 2-3 in girls and testicular volume Ͻ 10 ml in boys (22), with a GnRHa stimulating test indicating central puberty (23)]; 4) current height SDS less than Ϫ2.5 SDS and/or AH expectation less than Ϫ2.5 SDS (defined as a height at start of puberty Ͻ 140 cm), based on Dutch references (24); 5) well-documented growth data from birth to start of treatment; and 6) normal karyotype in all girls.…”

Beneficial Effect of Growth Hormone Treatment on Health-Related Quality of Life in Children with Prader-Willi Syndrome: A Randomized Controlled Trial and Longitudinal Study

“…Two years of GH treatment improved HRQOL, according to both patients and parents. Improvement in HRQOL during long-term GH treatment was also observed in short children born small for gestational age [30,31]. …”