***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 assess the prevalence of urinary incontinence and associated vaginal squeeze pressure in primiparous women with and without previous gestational diabetes mellitus two years post-cesarean delivery . METHODS : Primiparous women who delivered by cesarean two years previously were interviewed about the delivery and the occurrence of incontinence . Incontinence was reported by the women and vaginal pressure evaluated by a Perina perineometer . Sixty-three women with gestational diabetes and 98 women without the disease were screened for incontinence and vaginal pressure . Multiple logistic regression models were used to evaluate the independent effects of gestational diabetes . RESULTS : The prevalence of gestational incontinence was higher among women with gestational diabetes during their pregnancies ( 50.8 % vs. 31.6 % ) and two years after a cesarean ( 44.8 % vs. 18.4 % ) . Decreased vaginal pressure was also significantly higher among women with gestational diabetes ( 53.9 % vs. 37.8 % ) . Maternal weight gain and newborn weight were risk factors for decreased vaginal pressure . Maternal age , gestational incontinence and decreased vaginal pressure were risk factors for incontinence two years after a cesarean . In a multivariate logistic model , gestational diabetes was an independent risk factor for gestational incontinence . CONCLUSIONS : The prevalence of incontinence and decreased vaginal pressure two years post-cesarean were elevated among women with gestational diabetes compared to women who were normoglycemic during pregnancy . We confirmed an association between gestational diabetes mellitus and a subsequent decrease of vaginal pressure two years post-cesarean . These results may warrant more comprehensive prospect i ve and translational studies In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias Background Antenatal preparation programmes are recommended worldwide to promote a healthy pregnancy and greater autonomy during labor and delivery , prevent physical discomfort and high levels of anxiety . The objective of this study was to evaluate effectiveness and safety of a birth preparation programme to minimize lumbopelvic pain , urinary incontinence , anxiety , and increase physical activity during pregnancy as well as to compare its effects on perinatal outcomes comparing two groups of nulliparous women . Methods A r and omized controlled trial was conducted with 197 low risk nulliparous women aged 16 to 40 years , with gestational age ≥ 18 weeks . Participants were r and omly allocated to participate in a birth preparation programme ( BPP ; n=97 ) or a control group ( CG ; n=100 ) . The intervention was performed on the days of prenatal visits , and consisted of physical exercises , educational activities and instructions on exercises to be performed at home . The control group followed a routine of prenatal care . Primary outcomes were urinary incontinence , lumbopelvic pain , physical activity , and anxiety . Secondary outcomes were perinatal variables . Results The risk of urinary incontinence in BPP participants was significantly lower at 30 weeks of pregnancy ( BPP 42.7 % , CG 62.2 % ; relative risk [ RR ] 0.69 ; 95 % confidence interval [ CI ] 0.51 - 0.93 ) and at 36 weeks of pregnancy ( BPP 41.2 % , CG 68.4 % ; RR 0.60 ; 95%CI 0.45 - 0.81 ) . Participation in the BPP encouraged women to exercise during pregnancy ( p=0.009 ) . No difference was found between the groups regarding to anxiety level , lumbopelvic pain , type or duration of delivery and weight or vitality of the newborn infant . Conclusions The BPP was effective in controlling urinary incontinence and to encourage the women to exercise during pregnancy with no adverse effects to pregnant women or the fetuses . Trial registration Clinical trials.gov , ( NCT01155804 OBJECTIVE We have studied the effect of moderate physical activity that is performed by healthy women during their entire pregnancy on their perception of health status . STUDY DESIGN Eighty sedentary women were assigned r and omly to either an exercise group ( n = 40 ) or a control group ( n = 40 ) . Maternal perception of health status and several pregnancy outcomes were recorded . RESULTS Significant differences ( P = .03 ) were found between study groups in the percentage of women who perceived their health status as " very good " ; the values that corresponded to the exercise group ( n = 18 ; 54.5 % ) were better than those of the control group ( n = 9 ; 27.3 % ) . In addition , the women of the exercise group gained less weight ( 11,885 ± 3146 g ) than those of the control group ( 13,903 ± 2113 ; P = .03 ) . CONCLUSION A moderate physical activity program that is performed over the first , second , and third trimester of pregnancy improves the maternal perception of health status OBJECTIVE : To compare , in an unselected population of nulliparous pregnant women , the postnatal effect of prenatal supervised pelvic floor muscle training with written instructions on postpartum urinary incontinence ( UI ) . METHODS : In a r and omized controlled trial in two parallel groups , 282 women were recruited from five university teaching hospitals in France and r and omized during the second trimester of pregnancy . The physiotherapy group received prenatal individually supervised exercises . Both groups received written instructions about how to perform exercises at home . Women were blindly assessed at baseline , end of pregnancy , and 2 and 12 months postpartum . The primary outcome measured was UI severity , assessed with an International Consultation on Incontinence Question naire-Urinary Incontinence Short Form score ( range 0–21 ; 1–5 is slight UI ) at 12 months postpartum ; other outcomes were UI prevalence and pelvic floor troubles assessed using self-administered question naires . To give a 1-point difference in UI severity score , we needed 91 women in each group ( st and ard deviation 2.4 , & agr;=0.05 , & bgr;=0.20 , and bilateral analysis ) . RESULTS : Between February 2008 and June 2010 , 140 women were r and omized in the physiotherapy group and 142 in the control group . No difference was observed between the two groups in UI severity , prevalence , or pelvic floor troubles at baseline , end of pregnancy , and at 2 and 12 months postpartum . At 12 months postpartum , the primary outcome was available for 190 women ( 67.4 % ) ; mean UI severity was 1.9 in the physiotherapy group compared with 2.1 in the control group ( P=.38 ) . CONCLUSION : Prenatal supervised pelvic floor training was not superior to written instructions in reducing postnatal UI . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov ; www . clinical trials.gov , NCT00551551 . LEVEL OF EVIDENCE : Background Stress urinary incontinence ( SUI ) is a prevalent and costly condition which may be treated surgically or by physical therapy . The aim of this review was to systematic ally assess the literature and present the best available evidence for the efficacy and effectiveness of pelvic floor muscle training ( PFMT ) performed alone and together with adjunctive therapies ( eg biofeedback , electrical stimulation , vaginal cones ) for the treatment of female SUI . Methods All major electronic sources of relevant information were systematic ally search ed to identify peer- review ed English language abstract s or papers published between 1995 and 2005 . R and omised controlled trials ( RCTs ) and other study design s eg non-r and omised trials , cohort studies , case series , were considered for this review in order to source all the available evidence relevant to clinical practice . Studies of adult women with a urodynamic or clinical diagnosis of SUI were eligible for inclusion . Excluded were studies of women who were pregnant , immediately post-partum or with a diagnosis of mixed or urge incontinence . Studies with a PFMT protocol alone and in combination with adjunctive physical therapies were considered . Two independent review ers assessed the eligibility of each study , its level of evidence and the method ological quality . Due to the heterogeneity of study design s , the results are presented in narrative format . Results Twenty four studies , including 17 RCTs and seven non- RCTs , met the inclusion criteria . The method ological quality of the studies varied but lower quality scores did not necessarily indicate studies from lower levels of evidence . This review found consistent evidence from a number of high quality RCTs that PFMT alone and in combination with adjunctive therapies is effective treatment for  women  with  SUI  with rates of ' cure ' and ' cure/improvement ' up to 73 % and 97 % respectively . The contribution of adjunctive therapies is unclear and there is limited evidence about treatment outcomes in primary care setting s. Conclusion There is strong evidence for the efficacy of physical therapy for the treatment for SUI in women but further high quality studies are needed to evaluate the optimal treatment programs and training protocol s in subgroups of women and their effectiveness in clinical practice We have studied the pelvic floor musculature and its innervation in 14 of 24 ( 58 per cent ) multiparous women who had been recruited into a study of the effect of childbirth on the pelvic floor as part of a prospect i ve investigation that began in 1983 . These 24 women had all delivered by the vaginal route without forceps assistance .  Five of the 14 had developed clinical symptoms of stress incontinence 5 years later ; two of them had had a further uncomplicated vaginal delivery during this time . There was manometric and neurophysiological evidence of weakness because of partial denervation of the pelvic floor striated sphincter musculature , with pudendal neuropathy , which was more marked in those women with incontinence . These findings provide direct evidence for the hypothesis that pudendal neuropathy due to vaginal delivery persists and may worsen with time AIMS To investigate the effect of pelvic floor muscle training ( PFMT ) taught in a general exercise class during pregnancy on the prevention of  urinary incontinence ( UI ) in nulliparous continent pregnant women . METHODS This was a unicenter two armed r and omized controlled trial . One hundred sixty-nine women were r and omized by a central computer system to an exercise group ( EG ) ( exercise class including PFMT ) ( n = 73 ) or a control group ( CG ) ( n = 96 ) . 10.1 % loss to follow-up : 10 from EG and 7 from CG . The intervention consisted of 70 - 75 sessions ( 22 weeks , three times per week , 55 - 60 min/session including 10 min of PFMT ) . The CG received usual care ( which included follow up by midwifes including information about PFMT ) . Questions on prevalence and degree of UI were posed before ( week 10 - 14 ) and after intervention ( week 36 - 39 ) using the International Consultation on Incontinence Question naire-Urinary Incontinence Short Form ( ICIQ-UI SF ) . RESULTS At the end of the intervention , there was a statistically significant difference in favor of the EG . Reported frequency of UI [ Never : CG : 54/60.7 % , EG : 60/95.2 % ( P < 0.001 ) ] . Amount of leakage [ None : CG : 45/60.7 % , EG : 60/95.2 % ( P < 0.001 ) ] . There was also a statistically significant difference in ICIQ-UI SF Score between groups after the intervention period [ CG : 2.7 ( SD 4.1 ) , EG : 0.2 ( SD 1.2 ) ( P < 0.001 ) ] . The estimated effect size was 0.8 . CONCLUSION PFMT taught in a general exercise class three times per week for at least 22 weeks , without former assessment of ability to perform a correct contraction was effective in primary prevention of UI in primiparous pregnant women AIM This article is a report of a study of the effects of a pelvic floor muscle exercise programme on the severity of  stress urinary incontinence in pregnant women . BACKGROUND Pregnancy is main risk factor for the development of stress urinary incontinence . Stress urinary incontinence can be cured by pelvic floor muscle exercise which is a safe inexpensive treatment with no complications and does not require the use of instruments . METHODOLOGY A quasi-experimental study , pre-post test with 
    Output:
    
When we analysed the data by whether women were continent or incontinent prior to the intervention , exercise was beneficial at preventing the development of UI in women with continence , but not effective in treating UI in women with incontinence .
Conclusion Prenatal exercise including PFMT reduced the odds and symptom severity of prenatal and postnatal UI .
This was the case for women who were continent before the intervention .
Among women who were incontinent during pregnancy  , exercise training was not therapeutic