***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To investigate the association between ( self-reported )  maternal pre-pregnancy body mass index ( p BMI )  , and child ’s weight , height and BMI at age 14 months . Design : Prospect i ve multi-ethnic community-based cohort study . Setting : Amsterdam , The Netherl and s. Participants : 8266 pregnant women from the Amsterdam Born Children and their Development study , filled out a question naire covering socio-demographic data , obstetric history , lifestyle , dietary habits and psychosocial factors , 2 weeks after their first antenatal visit .  7730 gave birth to a viable term singleton infant with information on birth weight , gender and pregnancy duration . Growth data were available for 3171 of these children . Main outcome measures : Weight ( g ) , height ( cm ) and BMI ( kg/m2 ) of the child at age 14 months . Results : p BMI was linearly associated with weight and BMI of the child at age 14 months . One unit increase in p BMI result ed in an increment of 29 g ( 95 % CI 19 to 39 ) in weight and 0.041 kg/m2 ( 95 % CI 0.030 to 0.053 ) in BMI . The effect size decreased after adjustment for birth weight ( weight : β coefficient 19 g , 95 % CI 10 to 28 ; BMI : β coefficient 0.034 kg/m2 , 95 % CI 0.023 to 0.046 ) and hardly changed after adjustment for all other variables ( weight : β coefficient 21 g , 95 % CI 11 to 30 ; BMI : β coefficient 0.031 kg/m2 , 95 % CI 0.019 to 0.043 ) . p BMI was not related to height . Conclusions : p BMI is an independent determinant of weight and BMI of the child at age 14 months . At least one third of this effect is mediated through birth weight OBJECTIVE To evaluate whether morbidly obese women have an increased risk of pregnancy complications and adverse perinatal outcomes . METHODS In a prospect i ve population -based cohort study , 3,480 women with morbid obesity , defined as a body mass index ( BMI ) more than 40 , and 12,698 women with a BMI between 35.1 and 40 were compared with normal-weight women ( BMI 19.8 - 26 ) . The perinatal outcome of singletons born to women without insulin-dependent diabetes mellitus was evaluated after suitable adjustments . RESULTS In the group of morbidly obese mothers ( BMI greater than 40 ) as compared with the normal-weight mothers , there was an increased risk of the following outcomes ( adjusted odds ratio ; 95 % confidence interval ) : preeclampsia ( 4.82 ; 4.04 , 5.74 ) , antepartum stillbirth ( 2.79 ; 1.94 , 4.02 ) , cesarean delivery ( 2.69 ; 2.49 , 2.90 ) , instrumental delivery ( 1.34 ; 1.16 , 1.56 ) , shoulder dystocia ( 3.14 ; 1.86 , 5.31 ) , meconium aspiration ( 2.85 ; 1.60 , 5.07 ) , fetal distress ( 2.52 ; 2.12 , 2.99 ) , early neonatal death ( 3.41 ; 2.07 , 5.63 ) , and large-for-gestational age ( 3.82 ; 3.50 , 4.16 ) . The associations were similar for women with BMI s between 35.1 and 40 but to a lesser degree . CONCLUSION Maternal morbid obesity in early pregnancy is strongly associated with a number of pregnancy complications and perinatal conditions . LEVEL OF EVIDENCE Low maternal prepregnancy BMI is associated with adverse birth outcomes , but the BMI at which risk increases is not well defined . We assessed whether the relationship between prepregnancy BMI and birth outcomes is influenced by the extent to which mothers were underweight in a prospect i ve study in Anhui , China . The women ( n = 575 ) were 20 - 34 y old , married , nulliparous and nonsmokers . All measures of infant growth increased with increasing maternal BMI until a plateau was reached at a BMI of 22 - 23 kg/m2 . Infants born to the 27 % of women who were severely underweight before pregnancy ( BMI < or = 18.5 kg/m2 ) were at increased risk for fetal growth deficits associated with infant morbidity . Compared with a normal BMI , being severely underweight was associated with mean ( + /- SEM ) reductions of 219 + /- 40 g in infant birthweight and 6.7 + /- 1.3 % in the birthweight ratio and an 80 % increase in risk of intrauterine growth restriction [ odds ratio ( OR ) 1.8 ; 95 % CI : 1.0 , 3.3 ; P = 0.05 ] . Being severely underweight was also associated with smaller infant head circumference and lower ponderal index . Being moderately underweight ( 18.5 < BMI < 19.8 kg/m2 ) was not significantly associated with adverse pregnancy outcomes . Gestational age and risk of preterm birth were not associated with maternal BMI . More than half of the women in this study were underweight before pregnancy . Although being moderately underweight was not associated with increased risk of adverse pregnancy outcomes , being severely underweight was an important risk factor for reduced fetal growth One cost-effective strategy for controlling iron deficiency is the fortification of staple foods or condiments with iron . We evaluated the effectiveness of fortifying fish sauce with NaFeEDTA for improving iron status in women of childbearing age in Vietnam in a double-blind intervention with r and omization by village . All families in the selected villages were supplied with fish sauce that was either unfortified ( Group C , 10 villages ) or fortified with NaFeEDTA [ 9 mmol ( 500 mg ) Fe/L , Group F , 11 villages ] for 18 mo . The effect of fortification was assessed in the 576 women ( n = 288/group ) by measuring hemoglobin and serum ferritin ( SF ) at 6 , 12 , and 18 mo . Analysis of the group x time interaction using a repeated- measures test for each response demonstrated a significant effect of fortification on hemoglobin ( P = 0.039 ) and log SF ( P < 0.0001 ) in Group F with no significant changes in Group C. The prevalence of iron deficiency ( SF < 12 microg/L ) decreased from 22.3 to 4.0 % and the prevalence of anemia ( hemoglobin < 120 g/L ) from 24.7 to 8.5 % in Group F with no significant changes in Group C. NaFeEDTA fortification of fish sauce is an effective method for reducing the prevalence of iron deficiency in women in Vietnam BACKGROUND There is a growing interest in periconceptional iron supplementation in developing countries by research ers and policy makers ; however , there are no r and omized controlled trials that examine the effectiveness of this strategy in decreasing  anemia during pregnancy . OBJECTIVE The aim was to determine whether periconceptional iron supplementation reduces anemia during pregnancy . DESIGN A r and omized , double-blind , controlled trial was conducted in rural Bangladesh . Married , nulliparous women were r and omly assigned to receive daily iron and folic acid ( IFA ; 60 mg ferrous fumarate and 400 microg folic acid ) ( n = 134 ) or folic acid ( FA ; 400 microg ) ( n = 138 ) in the form of a powdered supplement added to food . Women were followed until pregnancy or the end of 9 mo . Primary outcomes included hemoglobin , plasma ferritin , and plasma transferrin receptor concentrations . RESULTS Among 88 pregnant women , periconceptional IFA in comparison with FA did not affect anemia or iron status at 15 wk gestation . However , each 1 % increase in adherence was associated with a 10-g/L increase in change in hemoglobin from baseline ( P = 0.03 ) , and those who initiated supplementation at a mean ( + /-SD ) time of 72.9 + /- 57.8 d before conception showed a 7.3-g/L increase in change in hemoglobin from baseline compared with those who initiated supplementation at 26.3 + /- 12.3 d after conception ( P = 0.01 ) . Among 146 nonpregnant women , IFA decreased anemia ( odds ratio : 0.19 ; 95 % CI : 0.04 , 0.95 ) and improved iron stores ( P = 0.001 ) more than did FA . CONCLUSION Good adherence and initiation of supplementation before conception are needed to reduce anemia during early pregnancy . This trial was registered at www . clinical trials.gov as NCT00953134 CONTEXT The prevalence of overweight and obesity in the United States remains high . Commercial weight loss programs may contribute to efforts to reduce the prevalence of overweight and obesity , although few studies have examined their efficacy in controlled trials . OBJECTIVE To test whether a free prepared meal and incentivized structured weight loss program promotes greater weight loss and weight loss maintenance at 2 years compared with usual care . DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled trial of weight loss and weight loss maintenance in 442 overweight or obese women ( body mass index , 25 - 40 ) aged 18 to 69 years ( mean age , 44 years ) conducted at US institutions over 2 years with follow-up between November 2007 and April 2010 . INTERVENTION The program , which involves in-person center-based or telephone-based one-to-one weight loss counseling , was available over a 2-year period . Behavioral goals were an energy-reduced , nutritionally adequate diet , facilitated by the inclusion of prepackaged food items in a planned menu during the initial weight loss phase , and increased physical activity . Participants assigned to usual care received 2 individualized weight loss counseling sessions with a dietetics professional and monthly contacts . MAIN OUTCOME MEASURES Weight loss and weight loss maintenance . RESULTS Weight data were available at 24 months for 407 women ( 92.1 % of the study sample ) . In an intent-to-treat analysis with baseline value substitution , mean weight loss was 7.4 kg ( 95 % confidence interval [ CI ] , 6.1 - 8.7 kg ) or 7.9 % ( 95 % CI , 6.5%-9.3 % ) of initial weight at 24 months for the center-based group , 6.2 kg ( 95 % CI , 4.9 - 7.6 kg ) or 6.8 % ( 95 % CI , 5.2%-8.4 % ) for the telephone-based group , and 2.0 kg ( 95 % CI , 0.6 - 3.3 kg ) or 2.1 % ( 95 % CI , 0.7%-3.5 % ) for the usual care control group after 24 months ( P < .001 for intervention effect ) . CONCLUSION Compared with usual care , this structured weight loss program result ed in greater weight loss over 2 years . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00640900 OBJECTIVES To evaluate the efficacy of an Internet behavioral weight loss program ; and determine if adding periodic in-person sessions to an Internet intervention improves outcomes . METHODS 481 healthy overweight adults ( 28 % minority ) were r and omized to one of 3 delivery methods of a behavioral weight loss program with weekly meetings : Internet ( n=161 ) , InPerson ( n=158 ) , or Hybrid ( Internet+InPerson , n=162 ) . Outcome variables were weight at baseline and 6 months and percent of subjects achieving a 5 and 7 % weight loss . The study took place in two centers in Vermont and Arkansas from 2003 to 2008 . RESULTS Conditions differed significantly in mean weight loss [ 8.0 ( 6.1 ) kg vs. 5.5 ( 5.6 ) kg vs. 6.0 ( 5.5 ) kg ] , for InPerson , Internet , and Hybrid respectively , p<0.01 , n=462 ) . Weight loss for InPerson was significantly greater than the Internet and Hybrid conditions ( p<0.05 ) . Although the proportion reaching a 5 % weight loss did not differ , the proportion losing 7 % did differ significantly ( 56.3 % vs. 37.3 % vs. 44.4 % for InPerson , Internet , and Hybrid respectively , p<0.01 ) . CONCLUSIONS These results demonstrate that the Internet is a viable alternative to in-person treatment for the delivery and dissemination of a behavioral weight-control intervention . The addition of periodic in-person sessions did not improve outcomes OBJECTIVE Maternal folate deficiency is associated with neural tube defects ( NTDs ) , the most common congenital birth defect at Maternity Hospital , Kathm and u , Nepal . NTDs can be prevented with periconceptional folic acid supplementation ( FAS ) . This study was performed to assess the awareness of FAS among women of reproductive age in Kathm and u. METHODS A semi-structured question naire was administered to 400 r and omly selected patients aged  
    Output:
    
Results Maternal pre-pregnancy weight is a significant factor in the preconception period with underweight contributing to a 32 % higher risk of preterm birth , and obesity more than doubling the risk for preeclampsia , gestational diabetes .
Overweight women are more likely to undergo a Cesarean delivery , and their newborns have higher chances of being born with a neural tube or congenital heart defect .
Among nutrition-specific interventions , preconception folic acid supplementation has the strongest evidence of effect , preventing 69 % of recurrent neural tube defects .
Multiple micronutrient supplementation shows promise to reduce the rates of congenital anomalies and risk of preeclampsia .