***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 
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    Input: Background Excessive  weight gain  during pregnancy is a major risk factor for macrosomia ( high birth weight delivery ) . This study aim ed to explore views about weight gain and lifestyle practice s during pregnancy among women with a history of macrosomia . Methods A qualitative descriptive study was conducted . Twenty-one second-time mothers whose first infant was macrosomic ( > 4 kg ) were recruited from a r and omised trial in a large maternity hospital in the Republic of Irel and .  Semi-structured interviews were conducted with participants at both 6 and 12 months after their second pregnancy . Inductive thematic analysis was used to identify distinct themes . Results The mothers believed in following their prenatal food cravings to meet their baby ’s needs , but this led some to eat excessively . Many of the women cut back heavily on physical activity during pregnancy due to perceived risks to the baby . Physical conditions and discomforts during pregnancy often limited maternal control over weight and lifestyle practice s. The women were not particularly concerned about weight gain during pregnancy and most did not favour the notion of introducing weight gain guidelines into routine antenatal care . Common differences perceived by the women between their first and second pregnancy included : increased concern about weight gain in their second pregnancy due to prior difficulties with postpartum weight loss and increased time dem and s in their second pregnancy impeded healthy lifestyle practice s. Most women did not alter their perspectives on weight gain and lifestyle practice s in their second pregnancy in response to having a macrosomic infant in their first pregnancy . Conclusions This analysis exposed numerous barriers to healthy pregnancy weight gain . The findings suggest that women may need to be advised to follow their prenatal food cravings in moderation . Pregnant women with children already may benefit from education on time-efficient methods of integrating healthy eating practice s and physical activity into their lifestyles . Women with a history of macrosomia may need information about the importance of avoiding high weight gain in subsequent pregnancies OBJECTIVE Excessive gestational weight gain ( GWG ) is an important contributing factor to the obesity epidemic in women and is associated with pregnancy complications . We investigated the relationship between GWG and caesarean delivery in labour , large for gestational age ( LGA ) , small for gestational age ( SGA ) infants and pregnancy-induced hypertension by maternal pre-pregnancy body mass index ( BMI ) in a contemporary nulliparous cohort . STUDY DESIGN Using 2009 Institute of Medicine guidelines , participants in the SCOPE study ( from Cork , Irel and , Auckl and , New Zeal and and Adelaide , Australia ) were classified into GWG categories ( low , normal and high ) according to pre-pregnancy BMI . Maternal characteristics and pregnancy outcomes were compared between weight gain categories . SGA and LGA were defined as < 10th and > 90th customised birthweight centile . Multivariable analysis adjusted for confounding factors that impact on GWG including BMI . RESULTS Of 1950 participants , 17.2 % ( n=335 ) achieved the recommended GWG  , 8.6 % ( n=167 ) had low and 74.3 % ( n=1448 ) had high GWG . Women with high GWG had increased rates of LGA infants [ adjusted OR 4.45 ( 95 % CI 2.49 - 7.99 ) ] and caesarean delivery in labour [ aOR 1.46 ( 1.03 - 2.07 ) ] . SGA was increased in women with low GWG [ aOR 1.79 ( 1.06 - 3.00 ) ] . CONCLUSION Three quarters of participants had high GWG  , which was associated with an independent risk of LGA infants and caesarean in labour . Low GWG was associated with SGA infants . These adverse outcomes are potentially modifiable by achievement of normal GWG , which should be an important focus of antenatal care OBJECTIVE The objective of the study was to evaluate the association between gestational weight gain , per the 2009 Institute of Medicine ( IOM ) recommendations , and offspring overweight/obesity at 2 - 5 years of age . STUDY DESIGN This was a prospect i ve cohort study of 4145 women who completed a health survey ( 2007 - 2009 ) and subsequently delivered a singleton at Kaiser Permanente Northern California ( 2007 - 2010 ) . Childhood overweight/obesity was defined as a body mass index ( BMI ) z-score of the 85th percentile or greater of the Centers for Disease Control and Prevention child growth st and ards . Gestational weight gain was categorized according to the 2009 IOM recommendations . Logistic regression was used ; meeting the IOM recommendations was the referent . RESULTS Exceeding the IOM recommendations was associated with a 46 % increase in odds of having an overweight/obese child ( odds ratio [ OR ] , 1.46 ; 95 % confidence interval [ CI ] , 1.17 - 1.83 ) , after adjusting for maternal prepregnancy BMI , race/ethnicity , age at delivery , education , child age , birthweight , gestational age at delivery , gestational diabetes , parity , infant sex , total metabolic equivalents , and dietary pattern . The OR ( 95 % CI ) for childhood overweight/obesity among women gaining below the IOM recommendations was 1.23 ( 0.88 - 1.71 ) . The associations between gaining outside the IOM recommendations and childhood obesity were stronger among women with a normal prepregnancy BMI ( OR , 1.63 ; 95 % CI , 1.03 - 2.57 ) ( below ) ; OR , 1.79 ; 95 % CI , 1.32 - 2.43 ) ( exceeded ) . CONCLUSION Gestational weight gain outside the IOM recommendations is associated with increased odds of childhood overweight/obesity , independent of several potential confounders and mediators . Gestational weight gain had a greater impact on childhood overweight/obesity among normal-weight women , suggesting that the effect may be independent of genetic predictors of obesity BACKGROUND Maternal obesity and excessive gestational weight gain ( GWG ) are major short- and long-term risk factors for maternal and fetal complications . OBJECTIVE The objective was to study whether a lifestyle intervention based on a brochure or on active education can improve dietary habits , increase physical activity ( PA ) , and reduce GWG in obese pregnant women . DESIGN In this r and omized controlled trial , 195 white , obese pregnant women [ age : 29 + or - 4 y ; body mass index ( in kg/m(2 ) ) ; 33.6 + or - 4.2 ] were r and omly assigned into 3 groups : a group that received nutritional advice from a brochure , a group that received the brochure and lifestyle education by a nutritionist , and a control group . Nutritional habits  were evaluated every trimester through 7-d food records . PA was evaluated with the Baecke question naire . RESULTS Energy intake did not change during pregnancy and was comparable in all groups . Fat intake , specifically saturated fat intake , decreased and protein intake increased from the first to the third trimester in the passive and active groups compared with an opposite change in the control group . Calcium intake and vegetable consumption increased during pregnancy in all groups . PA decreased in all groups , especially in the third trimester . No significant differences in GWG and obstetrical or neonatal outcome could be observed between the groups . CONCLUSIONS Both lifestyle interventions improved the nutritional habits of obese women during pregnancy . Neither PA nor GWG was affected BACKGROUND Although ooverweight and obesity are considered as a health problem that affects millions of people worldwide , the implication of socio-economic status ( SES ) in these healthy conditions have rarely been investigated . We evaluated the associations of overweight and obesity with SES , in a population based sample of Greek adults . METHODS During 2001 - 2002 we r and omly enrolled 1514 men ( 18 - 87 years old ) and 1528 women ( 18 - 89 years old ) , stratified by the age-sex distribution ( census 2001 ) of the Attica area , Greece . We studied several demographic , anthropometric , lifestyle , dietary and bio- clinical factors of the participants . SES ( low , middle and high ) was defined through the education and economical level of the participants . RESULTS The prevalence of overweight and obesity was 53 and 20 % in men , and 31 and 15 % in women , respectively , while an increase in the prevalence of obesity was observed with progressing age . Both men and women in the higher SES group had significantly lower prevalence of obesity as compared to the middle and lower SES group ( p<0.001 ) . However , multivariate analysis showed that the observed associations between SES and obesity were mainly explained by differences in physical activity status and energy intake of the participants . CONCLUSION Overweight and obesity seems to be a serious health problem , affecting more prominently people in the lower SES . However , eating and other lifestyle habits mainly explained the association between SES and obesity OBJECTIVE : To study how stress , life satisfaction and personality related factors , are related to long-term major weight gain .  DESIGN : Prospect i ve cohort study , with follow-up by question naire at 6 y and 15 y with a within- study replication . SUBJECTS : 5867 twin pairs aged 18–54 y at baseline , considered as two sets of unrelated individuals in analyses . MAIN OUTCOME MEASURES : Adjusted odds ratios ( OR ) for 10 kg weight gain over 6 y and 15 y. RESULTS : A high level of stress at baseline , was a predictor for major weight gain over 6 y , and this effect was consistent in some groups even over 15 y. Low levels of life satisfaction and high scores for neuroticism , were predictors for weight gain in older women . These effects were consistent , even after adjustments for confounding variables ( education , dieting , smoking , alcohol consumption and pregnancy in women ) . High levels of extroversion showed a trend towards lesser weight gain in younger men . CONCLUSION : Psychological traits did not affect the risk of major long-term weight gain in a uniform fashion . The observed effects of the factors related to psychological health were modest and consistent , but varied by age and gender . Thus , there may be trait-specific effects in selected subgroups of the population that should be further investigated OBJECTIVE The objective of this study was to estimate the effects of low and high gestational weight gain , in different maternal Body Mass Index ( BMI ) classes , on obstetric and neonatal outcomes . METHOD A prospect i ve population -based cohort study of 245,526 singleton term pregnancies . Women were grouped in five categories of BMI and in three gestational weight gain categories ; < 8 kg ( low weight gain ) , 8 - 16 kg and > 16 kg ( high weight gain ) . Obstetric and neonatal outcomes were evaluated after adjustments for maternal age , parity , smoking , year of birth . RESULT Obese women with low gestational weight gain had a decreased risk for the following outcomes ( adjusted odds ratio ; 95 % confidence interval ) : preeclampsia ( 0.52 ; 0.42 - 0.62 ) , cesarean section ( 0.81 ; 0.73 - 0.90 ) , instrumental delivery ( 0.75 ; 0.63 - 0.88 ) , and LGA births ( 0.66 ; 0.59 - 0.75 ) . There was a 2-fold increased risk for preeclampsia and LGA infants among average and overweight women with excessive weight gain . High gestational weight gain increased the risk for cesarean delivery in all maternal BMI classes . CONCLUSION The effects of high or low gestational weight gain differ depending on maternal BMI and the outcome variable studied . Obese women may benefit from a low weight gain during pregnancy OBJECTIVE : To study the associations between psychosocial working conditions and weight gain . DESIGN , SUBJECTS AND MEASUREMENTS : Data from postal question naires ( response rate 67 % ) sent to 40- to 60-y-old women ( n=7093 ) and men ( n=1799 ) employed by the City of Helsinki in 2000–2002 were analysed . Weight gain during the previous 12 months was the outcome variable in logistic regression analyses . Independent variables included Karasek 's job dem and s and job control , work fatigue , working overtime , work-related mental strain , social support and the work – home interface . The final models were adjusted for age , education , marital status , physical strain and body mass index . RESULTS : In the previous 12 months , 25 % of women and 19 % of men reported weight gain . Work fatigue and working overtime were associated with weight gain in both sexes . Women who were dissatisfied with combining paid work and family life were more likely to have gained weight .  Men with low job dem and s were less likely to have gained weight . All of these associations were independent of each other . CONCLUSIONS : Few work-related factors were associated with weight gain . However , our study suggests that work fatigue and working overtime are potential risk factors for weight gain . These findings need to be confirmed in prospect i ve studies BACKGROUND A high prevalence of gestational diabetes mellitus and type 2 diabetes has been observed among the Cree of James Bay , Quebec . To address this problem , a diet and activity intervention during pregnancy , which was based on social learning theory , was initiated in 4 Cree communities . METHODS A prospect i ve intervention compared dietary , weight and glycemic indicators for 107 control subjects and for 11 
    Output:
    
Through our integrative analysis , we identify women 's common perception on the struggle to enact health behaviors and physical , social , and environmental factors outside of their control .