***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 study the effect of integrated yoga on  Pregnancy experience , anxiety , and depression in normal pregnancy . METHODS This Prospect i ve R and omized control study recruited 96 women in 20th week of normal pregnancy .  Yoga group ( n = 51 ) practice d integrated yoga and control group ( n = 45 ) did st and ard antenatal exercises , one hour daily , from 20th to 36th week of gestation . Mann-Whitney and Wilcoxon 's tests were used for statistical analysis . RESULTS There was significant difference between groups ( Mann-Whitney p < 0.001 ) in all variables . There were significant changes within groups ( Wilcoxon 's p < 0.001 ) in both groups . Pregnancy related experience ( PEQ ) reduced in yoga by 26.86 % , State ( STAI I ) anxiety ( decreased 15.65 % in yoga , increased 13.76 % in control ) , Trait ( STAI II ) anxiety ( decreased 8.97 % in yoga , increased 5.02 % in control ) and Depression ( HADS ) ( decreased 30.67 % in yoga , increased 3.57 % in control ) . CONCLUSION Yoga reduces anxiety , depression and pregnancy related uncomfortable experiences Background An earlier study showed that a week of yoga practice was useful in stress management after a natural calamity . Due to heavy rain and a rift on the banks of the Kosi river , in the state of Bihar in north India , there were floods with loss of life and property . A week of yoga practice was given to the survivors a month after the event and the effect was assessed . Methods Twenty-two volunteers ( group average age ± S.D , 31.5 ± 7.5 years ; all of them were males ) were r and omly assigned to two groups , yoga and a non-yoga wait-list control group . The yoga group practice d yoga for an hour daily while the control group continued with their routine activities . Both groups ' heart rate variability , breath rate , and four symptoms of emotional distress using visual analog scales , were assessed on the first and eighth day of the program . Results There was a significant decrease in sadness in the yoga group ( p < 0.05 , paired t-test , post data compared to pre ) and an increase in anxiety in the control group ( p < 0.05 , paired t-test , post data compared to pre ) . Conclusions A week of yoga can reduce feelings of sadness and possibly prevent an increase in anxiety in flood survivors a month after the calamity . Trial Registration Clinical Trials Registry of India : Background Many women try to stop smoking in pregnancy but fail . One difficulty is that there is insufficient evidence that medications for smoking cessation are effective and safe in pregnancy and thus many women prefer to avoid these . Physical activity ( PA ) interventions may assist cessation ; however , trials examining these interventions have been too small to detect or exclude plausible beneficial effects . The London Exercise And Pregnant smokers ( LEAP ) trial is investigating whether a PA intervention is effective and cost-effective when used for smoking cessation by pregnant women , and will be the largest study of its kind to date . Methods / design The LEAP study is a pragmatic , multi-center , two-arm , r and omized , controlled trial that will target pregnant women who smoke at least one cigarette a day ( and at least five cigarettes a day before pregnancy ) , and are between 10 and 24 weeks pregnant . Eligible patients are individually r and omized to either usual care ( that is , behavioral support for smoking cessation ) or usual care plus a intervention ( entailing supervised exercise on a treadmill plus PA consultations ) . The primary outcome of the trial is self-reported and biochemically vali date d continuous abstinence from smoking between a specified quit date and the end of pregnancy . The secondary outcomes , measured at 1 and 4 weeks after the quit date , and at the end of pregnancy and 6 months after childbirth , are PA levels , depression , self-confidence , and cigarette withdrawal symptoms . Smoking status will also be self-reported at 6 months after childbirth . In addition , perinatal measures will be collected , including antenatal complications , duration of labor , mode of delivery , and birth and placental weight . Outcomes will be analyzed on an intention-to-treat basis , and logistic regression models used to compare treatment effects on the primary outcome . Discussion This trial will assess whether a PA intervention is effective when used for smoking cessation during pregnancy . Trial registration IS RCT BACKGROUND Postnatal and antenatal depression are a focus of considerable clinical and research attention , but little is known about the patterns of anxiety across this period . METHODS  Self-reported anxiety and depression were assessed at 18 and 32 weeks gestation and 8 weeks and 8 months postnatally in a prospect i ve longitudinal study of a community sample of women in Engl and ( n=8323 ) . RESULTS The majority of cases of postnatal depression were preceded by antenatal depression ; similarly , postnatal anxiety was preceded by antenatal anxiety . Despite the stability of anxiety and depression across this period , there was a mean decrease in both anxiety and depression . Finally , antenatal anxiety predicted postnatal depression at 8 weeks and 8 months , even after controlling for antenatal depression ( OR=3.22 , p<0.001 ) . LIMITATIONS Data were based on self-report only and there was evidence of selective attrition . CONCLUSION The findings confirm that antenatal anxiety occurs frequently , overlaps with depression and increases the likelihood of postnatal depression This study examined the effects of a yoga program during pregnancy , on  maternal comfort , labor pain , and birth outcomes .  A r and omized trial was conducted using 74-primigravid Thai women who were equally divided into two groups ( experimental and control ) . The yoga program involved six , 1-h sessions at prescribed weeks of gestation . A variety of instruments were used to assess maternal comfort , labor pain and birth outcomes . The experimental group was found to have higher levels of maternal comfort during labor and 2h post-labor , and experienced less subject evaluated labor pain than the control group . In each group , pain increased and maternal comfort decreased as labor progressed . No differences were found , between the groups , regarding pethidine usage , labor augmentation or newborn Apgar scores at 1 and 5 min . The experimental group was found to have a shorter duration of the first stage of labor , as well as the total time of labor CONTEXT A prior national survey documented the high prevalence and costs of  alternative medicine use in the United States in 1990 . OBJECTIVE To document trends in alternative medicine use in the United States between 1990 and 1997 . DESIGN Nationally representative r and om household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997 , respectively . PARTICIPANTS A total of 1539 adults in 1991 and 2055 in 1997 . MAIN OUTCOMES MEASURES Prevalence , estimated costs , and disclosure of alternative therapies to physicians . RESULTS Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8 % in 1990 to 42.1 % in 1997 ( P < or = .001 ) . The therapies increasing the most included herbal medicine , massage , megavitamins , self-help groups , folk remedies , energy healing , and homeopathy . The probability of users visiting an alternative medicine practitioner increased from 36.3 % to 46.3 % ( P = .002 ) . In both surveys alternative therapies were used most frequently for chronic conditions , including back problems , anxiety , depression , and headaches . There was no significant change in disclosure rates between the 2 survey years ; 39.8 % of alternative therapies were disclosed to physicians in 1990 vs 38.5 % in 1997 . The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 ( 64.0 % ) and 1997 ( 58.3 % ) ( P=.36 ) . Extrapolations to the US population suggest a 47.3 % increase in total visits to alternative medicine practitioners , from 427 million in 1990 to 629 million in 1997 , thereby exceeding total visits to all US primary care physicians . An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and /or high-dose vitamins ( 18.4 % of all prescription users ) . Estimated expenditures for alternative medicine professional services increased 45.2 % between 1990 and 1997 and were conservatively estimated at $ 21.2 billion in 1997 , with at least $ 12.2 billion paid out-of-pocket . This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations . Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $ 27.0 billion , which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services . CONCLUSIONS  Alternative medicine use and expenditures increased substantially between 1990 and 1997 , attributable primarily to an increase in the proportion of the population seeking alternative therapies , rather than increased visits per patient Background : Improvements in technology have increased the chances of survival for the micro-premature infant and the very low birth-weight infant but have significantly increased the financial burden of health care organizations . This economic burden has a significant impact on third-party payers and on society in general . Aim : The study was design ed to assess yoga therapy ( YT ) module on maternal stress level in high risk pregnancy . Subjects and Methods : In the present study , sixty-eight pregnant women ( 38 in the control group with st and ard antenatal care and 30 in the YT group ) with 27.2 ( 5.2 ) years of mean age recruited from the outpatient services of medical college and hospital in Bangalore , South India , were participated . The study was a single-blind r and omized controlled clinical trial . Perceived stress scale ( PSS ) was measured during the 12th , 20th , and 28th weeks of pregnancy . SPSS version 16.0 ( Chicago , IL , USA ) was used for all data analysis . When the data were found to be normally distributed , the RMANOVA were used to assess the PSS scores between the yoga and control groups . Significant values were set at P < 0.05 . Results : There was a significant difference in the PSS level of the YT group with significantly reduced scores at the second follow-up ( 28th week of pregnancy ) compared to the control group ( P = 0.02 ) . Women who took part in the YT module reported significantly fewer pregnancy discomforts decrease in PSS ( P = 0.02 ) than the control group where the stress level was increased ( RMANOVA test using SPSS-16 ) . Conclusion : The present study suggests that the YT module can decrease the stress level during high-risk pregnancy complications . Thus , practicing YT during high-risk pregnancy is not only a cost-effective option but also a feasible and safe option . Additional well- design ed studies are needed before a strong recommendation can be made The purpose of this study was to compare the effects of yoga ( physical activity ) versus social support ( verbal activity ) on prenatal and postpartum depression . Ninety-two prenatally depressed women were r and omly assigned to a yoga or a social support control group at 22 weeks gestation . The yoga group participated in a 20-min group session ( only physical poses ) once per week for 12 weeks . The social support group ( a leaderless discussion group ) met on the same schedule . At the end of the first and last sessions the yoga group reported less depression , anxiety , anger , back and leg pain as compared to the social support group . At the end of the last session the yoga group and the support group did not differ . They both had lower depression ( CES-D ) , anxiety ( STAI ) , and anger ( STAXI ) scores and improved relationship scores . In addition , cortisol levels decreased for both groups following each session . Estriol and progesterone levels decreased after the last session . At the postpartum follow-up assessment depression and anxiety levels were lower for both groups OBJECTIVE To study the effect of integrated yoga practice and guided yogic relaxation on both perceived stress and measured autonomic response in healthy pregnant women . METHOD The 122 healthy women recruited between the 18th and 20th week of pregnancy at prenatal clinics in Bangalore , India , were r and omized to  practicing yoga and deep relaxation or st and ard prenatal exercises 1-hour daily . The results for the 45 participants per group who completed the study were evaluated by repeated measures analysis of variance . RESULTS Perceived stress decreased by 31.57 % in the yoga group and increased by 6.60 % in the control group ( P=0.001 ) . During a guided relaxation period in the yoga group , compared with values obtained before a practice session , the high-frequency b and of the heart rate variability spectrum ( parasympathetic ) increased by 64 % in the 20th week and by 150 % in the 36th week , and both the low-frequency b and ( sympathetic ) , and the low-frequency to high-frequency ratio were concomitantly reduced ( P<0.001 between the 2 groups ) . Moreover , the low-frequency b and remained decreased after deep relaxation 
    Output:
    
Conclusions Prenatal yoga intervention in pregnant women may be effective in partly reducing depressive symptoms