***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: BACKGROUND Reliable evidence about the effect of  female genital mutilation ( FGM )  on obstetric outcome is scarce . This study examines the effect of different types of FGM on obstetric outcome . METHODS 28 393 women attending for singleton delivery between November , 2001 , and March , 2003 , at 28 obstetric centres in Burkina Faso , Ghana , Kenya , Nigeria , Senegal , and Sudan were examined before delivery to ascertain whether or not they had undergone FGM , and were classified according to the WHO system : FGM I , removal of the prepuce or clitoris , or both ; FGM II , removal of clitoris and labia minora ; and FGM III , removal of part or all of the external genitalia with stitching or narrowing of the vaginal opening . Prospect i ve information on demographic , health , and reproductive factors was gathered . Participants and their infants were followed up until maternal discharge from hospital . FINDINGS Compared with women without FGM , the adjusted relative risks of certain obstetric complications were , in women with FGM I , II , and III , respectively : caesarean section 1.03 ( 95 % CI 0.88 - 1.21 ) , 1.29 ( 1.09 - 1.52 ) , 1.31 ( 1.01 - 1.70 ) ; postpartum haemorrhage 1.03 ( 0.87 - 1.21 ) , 1.21 ( 1.01 - 1.43 ) , 1.69 ( 1.34 - 2.12 ) ; extended maternal hospital stay 1.15 ( 0.97 - 1.35 ) , 1.51 ( 1.29 - 1.76 ) , 1.98 ( 1.54 - 2.54 ) ; infant resuscitation 1.11 ( 0.95 - 1.28 ) , 1.28 ( 1.10 - 1.49 ) , 1.66 ( 1.31 - 2.10 ) , stillbirth or early neonatal death 1.15 ( 0.94 - 1.41 ) , 1.32 ( 1.08 - 1.62 ) , 1.55 ( 1.12 - 2.16 ) , and low birthweight 0.94 ( 0.82 - 1.07 ) , 1.03 ( 0.89 - 1.18 ) , 0.91 ( 0.74 - 1.11 ) . Parity did not significantly affect these relative risks . FGM is estimated to lead to an extra one to two perinatal deaths per 100 deliveries . INTERPRETATION Women with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes . Risks seem to be greater with more extensive FGM In a prospect i ve community based study of the distribution and determinants of  stillbirths in a rural area of Maharashtra , India , that was carried out for two years , 3129 singleton and 22 twin births were recorded in a population of 47 000 . Of the 3173 babies , 85 singletons and five of the twins were stillborn giving a stillbirth rate of 28.4/1000 births . The causes of stillbirths are analysed and the possibility of reducing the unacceptably high stillbirth rate by adequate training of grassroot level workers in screening pregnant women for detection of " at risk " mothers and their timely referral is discussed At an antenatal clinic in St. Thomas 's Hospital , London , 246 expectant mothers were r and omly allocated to hold either their own maternity case notes or the st and ard co-operation card . Information was collected on three occasions during their care on attitudes and health behaviour . Clinical outcomes were recorded and the effects of the two systems on clinic administration were observed . More of the notes group expressed satisfaction with most aspects of their care and delivery and significantly more of the notes group felt well informed and satisfied with their companion during labour . There were no differences in clinical outcomes between the two groups except that , for no identifiable systematic reason , there were more assisted deliveries among the notes group . A number of administrative advantages result ed from mothers holding their own notes and although initial reservations were found amongst professional staff interviewed at the start of the study , the results proved persuasive and the practice of giving mothers their own notes is now to be extended throughout the department The effects on  pregnancy outcome  and  maternal iron status of powdered milk ( PUR ) and a milk-based fortified product ( V-N ) were compared in a group of underweight gravidas . These take-home products were distributed during regular prenatal visits . Women in the V-N group had greater weight gain ( 12.29 vs 11.31 kg , p less than 0.05 ) and mean birth weights ( 3178 vs 3105 g , p less than 0.05 ) than those in the PUR group . Values for various indicators of maternal Fe status were also higher in the V-N group . Compared with self-selected noncompliers , similar in all control variables to compliers , children of women who consumed powdered milk or the milk-based fortified product had mean birth weights that were higher by 258 and 335 g , respectively . Data indicate a beneficial effect of the fortified product on both maternal nutritional status and fetal growth BACKGROUND Multiple micronutrient deficiencies may contribute to low birth weight , which is a major global determinant of mortality . OBJECTIVE We assessed the effect of prenatal multimicronutrient supplementation on gestational length and birth size . DESIGN We conducted a r and omized , placebo-controlled , double-blind effectiveness trial among antenatal care attendees in Harare , Zimbabwe . Pregnant women ( 22 - 35 wk of gestation ) were r and omly allocated to receive a multimicronutrient or placebo supplement daily until delivery . Supplementation with iron and folic acid was part of antenatal care . RESULTS Of 1669 women , birth data were available from 1106 ( 66 % ) , of whom 360 ( 33 % ) had HIV infection . The mean gestational length was 39.1 wk , and 16.6 % of the women had a gestational length < 37 wk . The mean birth weight was 3030 g , and 10.5 % of the infants had a birth weight < 2500 g. Multimicronutrient supplementation was associated with tendencies for increased gestational length ( 0.3 wk ; 95 % CI : -0.04 , 0.6 wk ; P = 0.06 ) , birth weight ( 49 g ; -6 , 104 g ; P = 0.08 ) , and head circumference ( 0.2 cm ; -0.02 , 0.4 cm ; P = 0.07 ) but was not associated with low birth weight ( birth weight < 2500 g ) ( relative risk : 0.84 ; 0.59 , 1.18 ; P = 0.31 ) . The effect of multimicronutrient supplementation on birth weight was not significantly different between HIV-uninfected ( 26 g ; -38 , 91 g ) and HIV-infected ( 101 g ; -3 , 205 g ) subjects ( interaction , P > 0.10 ) . CONCLUSION Antenatal multimicronutrient supplementation may be one strategy to increase birth size An intervention program was undertaken to assess dietary habits and the impact of nutrition education among pregnant women in the rural county of Florina , northern Greece . Analysis of dietary habits , nutrient intake , hemoglobin , and serum vitamin concentrations in an intervention and control group indicated that the population was adequately nourished although nutrient intake was below recommended levels for pregnant women . Nutrition counseling was associated with improvements in dietary intake and significantly greater maternal weight gain ( p less than 0.05 ) . Mean birth weight was slightly higher in the intervention group but so was the incidence of low birth weight ( 4.5 % vs 3.9 % ) . The prematurity rate was marginally lower in the intervention group ( p less than 0.04 ) , as was the number of perinatal deaths ( 9 vs 11 ) . The results indicate that nutrition counseling during pregnancy can improve dietary intake and maternal weight gain but the mediating influence on low frequency pregnancy outcomes is indeterminate in a population that is not nutritionally at risk BACKGROUND The effect of vitamin A supplementation on the survival of infants aged < 6 mo  is unclear . Because most infant deaths occur in the first few month of life , maternal supplementation may improve infant survival . OBJECTIVES The objective was to assess the effect of maternal vitamin A or beta-carotene supplementation on fetal loss and survival of infants < 6 mo of age . DESIGN Married women of reproductive age in 270 wards of Sarlahi district , Nepal , were eligible to participate . Wards were r and omly assigned to have women receive weekly doses of 7000 microg retinol equivalents as retinyl palmitate ( vitamin A ) , 42 mg all-trans-beta-carotene , or placebo . Pregnancies were followed until miscarriage , stillbirth , maternal death , or live birth of one or more infants , who were followed through 24 wk of age . RESULTS A total of 43559 women were enrolled ; 15832 contributed 17373 pregnancies and 15987 live born infants to the trial . The rate of fetal loss was 92.0/1000 pregnancies in the placebo group , comparable with rates in the vitamin A and beta-carotene groups , which had relative risks of 1.06 ( 95 % CI : 0.91 , 1.25 ) and 1.03 ( 95 % CI : 0.87 , 1.19 ) , respectively . The 24-wk mortality rate was 70.8/1000 live births in the placebo group , comparable with rates in the vitamin A and beta-carotene groups , which had relative risks of 1.05 ( 95 % CI : 0.87 , 1.25 ) and 1.03 ( 95 % CI : 0.86 , 1.22 ) , respectively . CONCLUSIONS Small weekly doses of vitamin A or beta-carotene given to women before conception , during pregnancy , and through 24 wk postpartum did not improve fetal or early infant survival in Nepal Maternal night blindness is common during pregnancy in many developing countries . Previous studies have demonstrated important consequences of maternal night blindness during pregnancy on the health of the mother and newborn infant . We compared birthweight , 6-mo infant mortality , morbidity , and growth among infants of women who did and did not report a history of night blindness from a community-based , r and omized trial of newborn vitamin A supplementation in south India .  Birthweight was measured within 72 h of delivery . Infants were followed until 6 mo of age for mortality and morbidity was assessed at household visits every 2 wk . Anthropometry was assessed at 6 mo of age . A total of 12,829 live-born infants were included , 680 of whom were infants of mothers with night blindness during the index pregnancy . Maternal night blindness was associated with an increased risk of low birthweight in a dose-dependent fashion based on birthweight cut-offs : < 2500 g , adjusted relative risk ( RR ) = 1.13 ( 95 % CI = 1.01 , 1.26 ) ; < 2000 g , adjusted RR = 1.70 ( 95 % CI = 1.27 , 2.26 ) ; < 1500 g , adjusted RR = 3.38 ( 95 % CI = 1.18 , 6.33 ) ; with an increased risk of diarrhea ( adjusted RR = 1.16 , 95 % CI = 1.03 , 1.30 ) , dysentery ( adjusted RR = 1.25 , 95 % CI = 1.03 , 1.53 ) , acute respiratory illness ( adjusted RR = 1.32 , 95 % CI = 1.21 , 1.44 ) , and poor growth at 6 mo ; underweight ( adjusted RR = 1.14 , 95 % CI = 1.02 , 1.26 ) , stunting ( adjusted RR = 1.19 , 95 % CI = 1.05 , 1.34 ) . Maternal night blindness was not associated with 6-mo infant mortality or wasting at 6 mo . This study demonstrates that there are important consequences to the infant of maternal vitamin A deficiency during pregnancy OBJECTIVE To evaluate the impact of a sustained , community-based collaborative approach to antenatal care services for Indigenous women . DESIGN Prospect i ve quality improvement intervention , the Mums and Babies program , in a cohort of women attending Townsville Aboriginal and Isl and ers Health Service , 1 January 2000 - 31 December 2005 ( MB group ) , compared with a historical control group ( PreMB group ) , 1 January 1998 - 30 June 1999 . MAIN OUTCOME MEASURES Proportion of women having inadequate antenatal care and screening ; perinatal indicators . RESULTS The number of antenatal visits per pregnancy increased from three ( interquartile range [ 
    Output:
    
Results From a programmatic perspective , none of the interventions achieved clear evidence of benefit .
Evidence for some socially mediated risk factors were identified , such as exposure to indoor air pollution and birth spacing , but still require the development of appropriate interventions .
Balanced protein-energy supplementation was associated with reduced stillbirth rates , but larger well- design ed trials are required to confirm findings .
Peri-conceptional folic acid supplementation significantly reduces neural tube defects , yet no significant associated reductions in stillbirth rates have been documented .
Evidence for other nutritional interventions including multiple micronutrient and Vitamin A supplementation is weak , suggesting the need for further research to assess potential of nutritional interventions to reduce stillbirths .
Many antepartum stillbirths are potentially preventable in low- and middle-income countries , particularly through dietary and environmental improvement , and through improving the quality of antenatal care – particularly including diagnosis and management of high-risk pregnancies – that pregnant women receive