Date of Award

Spring 5-2020

Degree Name

Master of Public Health (MPH)

Advisor(s)

MIRYOUNG LEE, PHD

Second Advisor

AUDREY CHOH, PHD

Abstract

Anti-müllerian hormone (AMH) plays an important role in sex differentiation of fetuses as well as in fertility in adulthood. During adolescence, AMH levels can be indicative of many disorders of sexual development for both males and females. In adults, AMH levels serve as an indication of the ovarian reserve. In adolescent girls, however, the role of the AMH during human growth and development has not been as well established. As skeletal age has been considered the best singular indication of maturity, and AMH had never previously been described by skeletal age, this study sought to describe patterns of change in AMH in relation to skeletal and chronological age and to assess the influence of skeletal maturation on AMH levels. This secondary data analysis study consisted of a subset of eighty-eight female Fels Longitudinal Study participants ranging in age from 8 to 18 years. Data analysis was completed in two phases. Phase I was a cross-sectional analysis that utilized linear regression modeling to examine log transformed AMH (AMHlog) levels by relative age, a difference between skeletal and chronological age, in a forward selection approach while adjusting for adiposity and cardiometabolic factors. Phase II was a longitudinal data analysis that utilized generalized linear mixed effect modeling to investigate AMHlog levels by relative age, also in a forward selection approach while adjusting for adiposity and cardiometabolic factors. Findings from Phase I analyses revealed that relative skeletal age was significantly related to AMHlog (β= -0.177, SE= 0.053, p= 0.001) while accounting for chronological age. Sex steroid binding globulin was also a significant predictor of AMHlog (β= 0.006, SE= 0.002, p= 0.011). Phase II results demonstrated that relative age was significantly related to changes in AMHlog (β= -0.073, SE= 0.032, p= 0.023). Also, glucose was significantly associated with the changes in AMHlog (β= -0.008, SE= 0.004, p= 0.044) in the adjusted analysis. In conclusion, AMHlog was found to have a similar relationship with skeletal age as it does with chronological age. However, a decrease in AMHlog levels was identified in individuals who experienced later maturation among relatively healthy adolescent girls in both cross-sectional and longitudinal analyses.

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