***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 Intrauterine and neonatal growth failure of very low birth weight ( VLBW ; < 1500 g ) infants may influence adult growth attainment and have long-term implication s for adult health . As part of a longitudinal study of VLBW infants , we sought to examine gender-specific changes in growth from birth to 20 years old and to identify the correlates of growth attainment at 20 years old . DESIGN , SETTING , PARTICIPANTS A cohort of 103 male and 92 female VLBW infants who had a mean birth weight of 1189 g and mean gestational age of 29.8 weeks , were born from 1977 through 1979 and treated at Rainbow Babies and Children 's Hospital in Clevel and , Ohio , and were free of neurosensory impairment were followed prospect ively from birth and compared with a population -based sample of 101 male and 107 female normal birth weight ( NBW ) controls selected at 8 years old .  Maternal sociodemographic status and infant birth and neonatal data did not differ significantly between male and female VLBW subjects . However , male VLBW subjects had significantly higher rates of rehospitalization during infancy than female VLBW ( 39 % vs 21 % ) . At 20 years , their rates of chronic illness were similar ( 18 % vs 24 % ) . MAIN OUTCOME MEASURES Weight and height z scores were computed at birth , 40 weeks , 8 and 20 months , and 8 and 20 years among the VLBW subjects , and at 8 and 20 years among the NBW controls . Body mass index ( BMI ) z scores were computed at 8 and 20 years . Among the VLBW subjects , gender-specific longitudinal growth measures were examined at birth , at the expected term date ( 40 weeks corrected age ) , and at 8 and 20 months , and 8 and 20 years of age . In addition , we compared the weight , height , and BMI of the VLBW and NBW controls at 8 and 20 years . Predictors of 20-year growth were examined via multivariate analyses . RESULTS Among the VLBW males , mean weight for age z scores at birth , 40 weeks , and 8 years were -0.7 , -1.8 , and -0.5 ; and height for age z scores were -1.2 , -2.6 , and -0.5 , respectively . For VLBW females , mean weight for age z scores were -1.1 , -2.0 , and -0.2 and height for age z scores were -1.2 , -2.4 , and -0.2 , respectively . At 8 years of age , VLBW males had a significantly lower mean weight , height , and BMI than NBW controls , whereas VLBW females differed significantly from their NBW controls in mean weight and BMI but not in height . Catch-up growth in weight , height , and BMI occurred between 8 and 20 years among VLBW females but not among VLBW males who remained significantly smaller than their controls at 20 years old . At 20 years mean weight of VLBW males was 69 kg versus 80 kg for controls ( z score -0.4 vs + 0.5 ) ; mean height was 174 cm versus 177 cm ( z score -0.4 vs + 0.03 ) and mean BMI was 23 versus 26 , respectively . For VLBW females , mean weight was 65 kg versus 68 kg for controls ( z score + 0.3 vs + 0.5 ) , mean height was 162 versus 163 cm ( z score -0.3 vs -0.1 ) and mean BMI was 25 versus 25 , respectively . Rates of obesity ( BMI > 30 ) for VLBW males were 7 % compared with 15 % for controls and for VLBW females 15 % compared with 18 % for controls . Age of menarche was 12.4 years for VLBW females and 12.3 years for controls . Nineteen ( 18 % ) male and 20 ( 22 % ) female VLBW subjects were born small for gestational age ( SGA ; weight less than -2 st and ard deviation for gestational age ) . At 20 years , significantly more SGA than appropriate for gestational age VLBW males remained subnormal ( less than -2 st and ard deviation ) in weight ( 32 % vs 6 % ) and height ( 21 % vs 4 % ) , whereas rates of subnormal growth did not differ significantly between SGA and appropriate for gestational age females ( weight 5 % vs 1 % , height 0 % vs 7 % ) . Predictor variables included in the multivariate analyses of 20-year growth attainment were maternal education and height , race , birth weight z score ( a measure of intrauterine growth failure ) , neonatal hospital stay ( a measure of neonatal illness ) , and chronic illness at 20 years . Twenty-year weight was predicted by black race and chronic illness among females . Twenty-year height was predicted by maternal height and birth weight z score among both males and females and by duration of neonatal hospital stay among males only . In a separate model , when we examined the effect of being SGA at birth instead of the effect of birth weight z score , SGA birth was predictive of 20-year height among males but not among females . CONCLUSIONS VLBW females catch up in growth by 20 years of age whereas VLBW males remain significantly shorter and lighter than controls . Since catch-up growth may be associated with metabolic and cardiovascular risk later in life , these findings may have implication s for the future adult health of VLBW survivors To assess whether antithrombotic prophylaxis with low-molecular-weight heparin effectively prevents recurrence of late pregnancy complications , 135 women with previous history of preeclampsia , hemolytic anemia , elevated liver enzymes and low platelet count syndrome , intrauterine fetal death , fetal growth restriction , or placental abruption who had been referred within the 12th gestational week were r and omized to medical surveillance alone ( n = 68 ) or combined to open-label nadroparin ( 3800 IU daily subcutaneous injections ) treatment ( n = 67 ) in the setting of a r and omized , parallel-group , superiority trial , run in Italy from April 2007 to April 2010 . Primary outcome was a composite end point of late-pregnancy complications . Analysis was by intention to treat . The study was stopped for futility at the time of the first planned interim analysis . Among the 128 women eventually available for final analyses , 13 of the 63 ( 21 % ) r and omized to nadroparin compared with 12 of the 65 ( 18 % ) on medical surveillance alone progressed to the primary end point . The absolute event risk difference between treatment arms ( 2.2 ; -1.6 to 16.0 ) was not statistically significant ( P = .76 ) . Thus , nadroparin did not prevent late-pregnancy complications in women at risk of recurrence . This finding challenges the role of antithrombotic prophylaxis with low-molecular-weight heparin in the prevention of recurrent late pregnancy complications The trial was registered at http://ricerca-clinica.agenziafarmaco.it as EudraCT 2006 - 004205 - 26 Objective Small for gestational age ( SGA ) infants comprise up to 50 % of all stillbirths and a minority are detected before birth . We aim ed to develop and vali date early pregnancy predictive models for SGA infants . Methods 5628 participants from SCOPE , a prospect i ve study of nulliparous pregnant women , were interviewed at 15±1 weeks ’ gestation  . Fetal anthropometry , uterine and umbilical Doppler studies  were performed at 20±1 weeks ’ . The cohort was divided into training ( n = 3735 ) and validation data sets ( n = 1871 ) . All-SGA ( birthweight < 10th customised centile ) , Normotensive-SGA ( SGA with normotensive mother ) and Hypertensive-SGA ( SGA with mother who developed hypertension ) were the primary outcomes . Multivariable analysis was performed using stepwise logistic regression firstly using clinical variables and then with clinical and ultrasound variables . Receiver operator curves were constructed and areas under the curve ( AUC ) calculated . Results 633 infants ( 11.3 % ) in the whole cohort were SGA ; 465 ( 8.3 % ) Normotensive-SGA and 165 ( 3.0 % ) Hypertensive-SGA . In the training data set risk factors for All-SGA at 15±1 weeks ’ included : family history of coronary heart disease , maternal birthweight < 3000 g and 3000 g to 3499 g compared with ≥3500 g , > 12 months to conceive , university student , cigarette smoking , proteinuria , daily vigorous exercise and diastolic blood pressure ≥80 . Recreational walking ≥4 times weekly , rhesus negative blood group and increasing r and om glucose were protective . AUC for clinical risk factors was 0.63 . Fetal abdominal or head circumference z scores < 10th centile and increasing uterine artery Doppler resistance at 20±1 weeks ’ were associated with increased risk . Addition of these parameters increased the AUC to 0.69 . Clinical predictors of Normotensive and Hypertensive-SGA were sub-groups of All-SGA predictors and were quite different . The combined clinical and ultrasound AUC for Normotensive and Hypertensive-SGA were 0.69 and 0.82 respectively . Conclusion Predictors for SGA of relevance to clinical practice were identified . The identity and predictive potential differed in normotensive women and those who developed hypertension OBJECTIVE The purpose of this study was to compare the use of low-dose aspirin alone with heparin and low-dose aspirin in the treatment of the antiphospholipid antibody syndrome . STUDY DESIGN A prospect i ve , single-center trial included 50 patients who were alternately assigned to treatment . Each patient had at least three consecutive spontaneous pregnancy losses , positive antiphospholipid antibodies on two occasions , and a complete evaluation . Data were compared by chi(2 ) analysis and Fisher 's exact test . RESULTS Viable infants were delivered of 11 of 25 ( 44 % ) women treated with aspirin and 20 of 25 ( 80 % ) women treated with heparin and aspirin ( p < 0.05 ) . There were no significant differences between the low-dose aspirin and the heparin plus low-dose aspirin groups with respect to gestational age at delivery ( 37.8 + /- 2.1 vs 37.2 + /- 3.4 weeks ) , number of cesarean sections ( 18 % vs 20 % ) , or complications . CONCLUSION Heparin plus low-dose aspirin provides a significantly better pregnancy outcome than low-dose aspirin alone does for antiphospholipid antibody-associated recurrent pregnancy loss OBJECTIVE To compare live birth rates in women with recurrent pregnancy loss ( RPL ) and either autoantibodies or a coagulation abnormality , treated with low molecular weight heparin plus aspirin ( LMWH/ASA ) or ASA alone  , and to place our results in context with other r and omized clinical trials ( RCT ) with similar cohorts . METHODS The HepASA Trial was an RCT including patients with a history of RPL and at least 1 of the following : antiphospholipid antibody ( aPL ) , an inherited thrombophilia , or antinuclear antibody . Treatment groups were stratified by aPL status and history of early versus late pregnancy losses . Patients received either LMWH/ASA or ASA alone . The primary outcome was live birth ; secondary outcomes included adverse events and bone loss at the spine and femoral neck . Literature over the past 20 years was review ed to identify comparable RCT . RESULTS Over 4 years , 859 women with RPL were screened : 88 ( 10.2 % ) fulfilled inclusion criteria , became pregnant and were r and omized to receive either LMWH/ASA or ASA alone . aPL were present in 42 ( 47.7 % ) patients in each group . The trial was stopped after 4 years when an interim analysis showed no difference in live birth rates in the 2 groups , and a lower rate of pregnancy loss in the ASA only group than expected . In the LMWH/ASA group , 35/45 ( 77.8 % ) had a live birth versus 34/43 ( 79.1 % ) in the ASA only group ( p = 0.71 ) . Neither number of prior losses nor aPL status was correlated with pregnancy outcome . There were no cases of pregnancy related thrombosis in either group . Mean change in BMD did not differ by treatment group at either the lumbar spine ( p = 0.57 ) or femoral neck ( p = 0.15 ) . RCT since 2000 for aPL positive women with RPL and similar inclusion criteria report a mean live birth rate of 75 % with either LMWH or ASA . CONCLUSION LMWH/ASA did not confer incremental benefit compared to ASA alone for this population . Regardless of treatment regimen , number of prior losses , or aPL positivity , almost 80 % of women in our RPL cohort had a successful pregnancy outcome . These findings contribute to a growing body of literature that contests the emerging st and ard of care comprising LMWH/ASA for this population Data from literature report that angiotensin-converting enzyme ( ACE ) insertion/deletion ( I 
    Output:
    
Discussion The EPPI trial has more focussed and clinical ly relevant inclusion criteria than other r and omised trials with a more restricted composite primary outcome .
The inclusion of st and ard use of aspirin ( and calcium ) for all participants will help to ensure that any differences observed in outcome are likely to be related to enoxaparin use .