human
***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 Though breast feeding is natural , during the first 2 - 3 days , when enough breast milk is not available with mother , she may introduce bottle feeding erroneously for improving nutrition to her baby . We studied the effect of antenatal expression of breast milk at term in reducing breast feeding failure as compared to conventional method of initiation of breast feeding . METHODS A prospect i ve study was carried out in 180 booked cases at term .  Daily expression of breast milk at least once a day after 37 weeks of pregnancy was introduced in r and omly selected 90 pregnant ladies . Prior examination was done to exclude any inverted or cracked nipples and appropriate treatment instituted . RESULT The study group who expressed breast milk daily after 37 weeks did not find it difficult to initiate breast feeding after vaginal or cesarean delivery . Sufficient milk started flowing within half an hour of initiation of breast feeding in most 85 ( 94.4 % ) subjects of study group as compared to 63 ( 70 % ) patients of control group , which was statistically significant . There was no increase in any delivery complication . There were two partial breast feeding failures in control group but none in study group . CONCLUSION Daily antenatal breast milk expression after 37 completed weeks of pregnancy significantly reduced the time for establishing full breast feeding and reduced breast feeding failures In many regions of the world , women breastfeed one child while pregnant with the next . Among rural Guatemalan women participating in a nutrition-supplementation trial , lactation overlapped with pregnancy in 253 of 504 ( 50.2 % ) of the pregnancies . For cases where overlap occurred , 41.4 % continued to breast-feed into the second trimester and 3.2 % , in the third trimester . The maternal and fetal responses to the energetic stresses of overlap and of the duration of the recuperative ( nonpregnant , nonlactating ) interval were assessed . Overlap result ed in increased supplement intake . Short recuperative periods ( less than 6 mo ) result ed in increased supplement intake and reduced maternal fat stores . The energetic stresses of overlap and short recuperative periods did not significantly affect fetal growth . The mother appears to buffer the energetic stress , protecting fetal growth . This research demonstrates that evidence of depletion of maternal nutrient stores caused by a dem and ing reproductive history is found when reproductive stress is characterized adequately Background Women with diabetes are sometimes advised to express breast milk antenatally to prepare for breastfeeding and to store colostrum for infant feeding in preventing or treating hypoglycaemia after the birth . The acceptability , risks and benefits of this practice have not been evaluated . This was aim ed to investigate the pattern of antenatal breast expression uptake and its relationship with birth outcomes in women with diabetes . Methods This was part of a two year retrospective cohort study of pregnant women with diabetes ( type 1 , 2 and gestational diabetes ) who gave birth during 2001–2003 in Derby Hospitals NHS Foundation Trust ( n = 94 ) . The information on the practice of antenatal breastfeeding expression and birth outcomes was collected via self-administered question naires and by examining maternity records . Results Thirty-seven percent of women ( 35/94 ) recalled that they were advised to express antenatally and 17 % did ( 16/94 ) . The mean gestational age at birth for women who h and -expressed was lower than that for those who did not ( mean difference ( MD ) ( 95 % confidence intervals ( CI ) ) : -1.2 ( −2.4 to 0.04 ) , p = 0.06 ) . A higher proportion of babies from the antenatal expression group were admitted to special care baby units ( SCBU ) ( MD ( 95 % CI ) : 21 % ( −3.9 to 46.3 ) . Conclusions Less than half the women who stated that they were advised to express , did so . There seems to be an indication that antenatal breast milk expression and lower gestational age at birth are associated . The trend of a higher rate of SCBU admission for babies from the breast milk expression group compared to those who did not express antenatally is of concern . An appropriately-powered r and omised controlled trial is needed to determine the safety of this practice and its acceptability to women and health professionals before it can be recommended for implementation in practice OBJECTIVE To test the hypothesis that long-term postnatal development may be modified by metabolic experiences in utero . RESEARCH DESIGN AND METHODS We enrolled offspring of women with pregestational diabetes ( this included insulin-dependent diabetes mellitus . [ 1DDM ] and non-insulin-dependent diabetes mellitus [ NIDDM ] ) and gestational diabetes in a prospect i ve study from 1977 through 1983 . Fetal /3-cell function was assessed by measurement of arrmiotic fluid insulin ( AF1 ) at 32–38 weeks gestation . Postnatally , plasma glucose and insulin  were measured yearly from 1.5 years of age after fasting and 2 h after 1.75 g/kg oral glucose . Control subjects had a single oral glucose challenge at 10 - 16 years . RESULTS In offspring of diabetic mothers , the prevalence of impaired glucose tolerance ( IGT ) ( 2-h glucose concentration > 7.8 mmol/1 ) was : 1.2 % at < 5 years , 5.4 % at 5–9 years , and 19.3 % at 10–16 years . The 88 offspring of diabetic mothers ( 12.3 ± 1.7 years ) , when compared with 80 control subjects of the same age and pubertal stage , had higher 2-h glucose ( 6.8 ±1.4 vs. 5.7 ± 0.9 mmol/1 , P < 0.001 ) and insulin ( 660 ± 720 vs. 455 ± 285 pmol/1 , P < 0.03 ) concentrations . The 17 subjects with IGT at > 10 years of age ( 9 boys and 8 girls ) include one girl with NIDDM . IGT was not associated with the etiology of the mother 's diabetes ( gestational versus pregestational ) or macrosomia at birth . IGT was found in only 3.7 % ( 1 of 27 ) of adolescents whose AFI was normal ( ≥100 pmol/l ) and 33.3 % ( 12 of 36 ) of those with elevated AFI ( P < 0.001 ) . Although most of the children with IGT are obese , AFI and obesity are independently associated with IGT by multiple logistic analysis . CONCLUSIONS In confirmation of our original hypothesis , IGT in the offspring is a long-term complication of maternal diabetes . Excessive insulin secretion in utero , as assessed by AFI concentration , is a strong predictor of IGT in childhood BACKGROUND Antenatal breast expression ( ABE ) has been taught in the past as breast preparation . Now some authorities are advising ABE and storage of colostrum for the feeding the newborn in the treatment and /or prevention of hypoglycaemia in the immediate postnatal period ( thus avoiding the need for formula supplementation ) . The actual incidence of ABE teaching amongst International Board Certified Lactation Consultant ( IBCLC ) Midwives is unknown . Results of this study will provide valuable baseline data for future r and omised controlled trials into this practice . RESEARCH QUESTION What are the teaching practice s surrounding ABE and the incidence of this type of teaching by IBCLC Midwives across Australia ? METHOD A descriptive cross-sectional Internet survey containing both quantitative and qualitative questions was sent to Australian IBCLC Midwives . Simple descriptive statistics was used to analyse quantitative data . Content analysis examined qualitative textual data of open-ended questions . FINDINGS Response rate was 27 % ( n=347/1269 ) . 93 % ( n=322 ) of those responding to the survey had heard of ABE . 60 % ( n=134 ) actively teach the practice . Descriptive statistics and content analysis revealed marked differences in teaching practice s amongst this specialised group of midwives . CONCLUSION This study suggested a large proportion of lactation qualified midwife respondents were aware of ABE and some currently teach the skill . However , advice given to women during pregnancy varied substantially Forster et al ( 2009 ) contend that the practice of recommending antenatal expressing and storing of colostrum by mothers with Type 1 diabetes should cease until its efficacy can be tested in a r and omised controlled trial ( RCT ) . This contention raises an ethical dilemma . The authors of the article conclude that considering that antenatal expression and storage of colostrum by pregnant Type 1 diabetic women gives their babies an extra amount of fluid that biochemically compares with colostrum if needed for hypoglycaemia , and that nipple stimulation has not been shown to induce labour , the practice should continue and women should be educated about this easy , positive and empowering practice The study evaluates breast stimulation and oxytocin infusion as methods for  cervical ripening in patients where an obstetric indication for induction of labour exists . Forty patients with a Bishop score of 5 or 6 were r and omly selected for either breast stimulation or oxytocin infusion . In a similar group of 20 cases , no method was employed . The Bishop score improved in 41.2 % of cases where breast stimulation was used as compared to 75 % where an oxytocin infusion was given . Three foetal deaths in the breast stimulation group brought the study to a stop after 17 cases . Cervical ripening with an  oxytocin infusion drip appears to be a better method since infusion dosage can be precisely controlled making the technique more predictable and reliable . Though breast stimulation is effective in ripening the cervix , it may be used only in cases of intrauterine foetal death as it may otherwise adversely affect foetal outcome This prospect i ve nationwide study conducted during 1982 - 1985 examined the rates of  hypertensive disorders , perinatal mortality and morbidity in 491 insulin-dependent diabetic pregnancies ( White 's classes : B , 164 ; C , 129 ; D , 172 ; F , 26 ) and in the total population of 279,000 . The rates of pregnancy-induced hypertension ( PIH ) or pre-eclampsia ( 20.6 % ) , premature delivery ( 24.6 % ) , and cesarean section ( 45.2 % ) in the diabetic group were more than four times higher than normal . PIH or preeclampsia occurred significantly ( p < 0.01 ) more frequently in patients with diabetic microangiopathy .  Mean birthweight was similar in the two population s but gestational age was significantly ( p < 0.001 ) shorter ( 38 weeks ) in the diabetic group . The rate of large for gestational age infants ( 20 % ) in the diabetic group was considerably above normal ( 3.5 % ) . Although perinatal mortality rate in the diabetic group was only 3.1 % , it was 4.4 times higher than normal ; five of ten fetal deaths were associated with poor glycemic control and thus may not really be unexplained . Neonatal morbidity was significantly more frequent in the diabetic group ; still , the incidence of idiopathic respiratory distress syndrome was only 1.6 % compared with 0.6 % in the general population . Discriminant analysis revealed that gestational age at birth and elevated maternal HbA1c values in early pregnancy independently of each other had a significant impact on the occurrence of neonatal morbidity OBJECTIVE infants of women with diabetes in pregnancy are at increased risk of hypoglycaemia . If the infant 's blood glucose is low and the mother is unable to breast feed/provide sufficient expressed breast milk , infants are often given formula . Some hospitals encourage women with diabetes to express breast milk before birth . However , there is limited evidence for this practice , including its impact on labour and birth , e.g. causing premature birth may be a concern . A pilot study was undertaken to establish the feasibility of conducting an adequately powered r and omised controlled trial to evaluate this practice . DESIGN consecutive eligible women with pre-existing or gestational diabetes ( requiring insulin ) , planning to breast feed and attending the study hospital were offered participation . INCLUSION CRITERIA 34 - 36 weeks of gestation ; singleton pregnancy ; cephalic presentation ; and able to speak , read and write in English . EXCLUSION CRITERIA history of spontaneous preterm birth , antepartum haemorrhage , placenta praevia and suspected fetal compromise . Women were encouraged to express colostrum twice a day from 36 weeks of gestation , and advised how to store the colostrum , which was frozen for their infant 's use after birth . They were asked to keep a diary documenting their expressing . DATA demographic question naire , telephone interview at six and 12 weeks postpartum and medical record data . SETTING a public , tertiary , women 's hospital in Melbourne , Australia . PARTICIPANTS 43 women with diabetes in pregnancy ( requiring insulin ) . FINDINGS cardiotocographs were undertaken after the first expressing episode and none of the infants showed any sign of fetal compromise . Forty per cent of infants received formula in the 24 hours postpartum . The proportion of infants receiving any breast milk at six weeks was 90 % , and this decreased to 75 % at 12 weeks . No women showed evidence of hypoglycaemia post expressing . The intervention was positively received by most women ; 95 % said that they would express antenatally again if the practice proved to be beneficial . The amount of colostrum varied according to the number of expressions , the length of time in 
    Output:
    
agent
***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 Though breast feeding is natural , during the first 2 - 3 days , when enough breast milk is not available with mother , she may introduce bottle feeding erroneously for improving nutrition to her baby . We studied the effect of antenatal expression of breast milk at term in reducing breast feeding failure as compared to conventional method of initiation of breast feeding . METHODS A prospect i ve study was carried out in 180 booked cases at term .  Daily expression of breast milk at least once a day after 37 weeks of pregnancy was introduced in r and omly selected 90 pregnant ladies . Prior examination was done to exclude any inverted or cracked nipples and appropriate treatment instituted . RESULT The study group who expressed breast milk daily after 37 weeks did not find it difficult to initiate breast feeding after vaginal or cesarean delivery . Sufficient milk started flowing within half an hour of initiation of breast feeding in most 85 ( 94.4 % ) subjects of study group as compared to 63 ( 70 % ) patients of control group , which was statistically significant . There was no increase in any delivery complication . There were two partial breast feeding failures in control group but none in study group . CONCLUSION Daily antenatal breast milk expression after 37 completed weeks of pregnancy significantly reduced the time for establishing full breast feeding and reduced breast feeding failures In many regions of the world , women breastfeed one child while pregnant with the next . Among rural Guatemalan women participating in a nutrition-supplementation trial , lactation overlapped with pregnancy in 253 of 504 ( 50.2 % ) of the pregnancies . For cases where overlap occurred , 41.4 % continued to breast-feed into the second trimester and 3.2 % , in the third trimester . The maternal and fetal responses to the energetic stresses of overlap and of the duration of the recuperative ( nonpregnant , nonlactating ) interval were assessed . Overlap result ed in increased supplement intake . Short recuperative periods ( less than 6 mo ) result ed in increased supplement intake and reduced maternal fat stores . The energetic stresses of overlap and short recuperative periods did not significantly affect fetal growth . The mother appears to buffer the energetic stress , protecting fetal growth . This research demonstrates that evidence of depletion of maternal nutrient stores caused by a dem and ing reproductive history is found when reproductive stress is characterized adequately Background Women with diabetes are sometimes advised to express breast milk antenatally to prepare for breastfeeding and to store colostrum for infant feeding in preventing or treating hypoglycaemia after the birth . The acceptability , risks and benefits of this practice have not been evaluated . This was aim ed to investigate the pattern of antenatal breast expression uptake and its relationship with birth outcomes in women with diabetes . Methods This was part of a two year retrospective cohort study of pregnant women with diabetes ( type 1 , 2 and gestational diabetes ) who gave birth during 2001–2003 in Derby Hospitals NHS Foundation Trust ( n = 94 ) . The information on the practice of antenatal breastfeeding expression and birth outcomes was collected via self-administered question naires and by examining maternity records . Results Thirty-seven percent of women ( 35/94 ) recalled that they were advised to express antenatally and 17 % did ( 16/94 ) . The mean gestational age at birth for women who h and -expressed was lower than that for those who did not ( mean difference ( MD ) ( 95 % confidence intervals ( CI ) ) : -1.2 ( −2.4 to 0.04 ) , p = 0.06 ) . A higher proportion of babies from the antenatal expression group were admitted to special care baby units ( SCBU ) ( MD ( 95 % CI ) : 21 % ( −3.9 to 46.3 ) . Conclusions Less than half the women who stated that they were advised to express , did so . There seems to be an indication that antenatal breast milk expression and lower gestational age at birth are associated . The trend of a higher rate of SCBU admission for babies from the breast milk expression group compared to those who did not express antenatally is of concern . An appropriately-powered r and omised controlled trial is needed to determine the safety of this practice and its acceptability to women and health professionals before it can be recommended for implementation in practice OBJECTIVE To test the hypothesis that long-term postnatal development may be modified by metabolic experiences in utero . RESEARCH DESIGN AND METHODS We enrolled offspring of women with pregestational diabetes ( this included insulin-dependent diabetes mellitus . [ 1DDM ] and non-insulin-dependent diabetes mellitus [ NIDDM ] ) and gestational diabetes in a prospect i ve study from 1977 through 1983 . Fetal /3-cell function was assessed by measurement of arrmiotic fluid insulin ( AF1 ) at 32–38 weeks gestation . Postnatally , plasma glucose and insulin  were measured yearly from 1.5 years of age after fasting and 2 h after 1.75 g/kg oral glucose . Control subjects had a single oral glucose challenge at 10 - 16 years . RESULTS In offspring of diabetic mothers , the prevalence of impaired glucose tolerance ( IGT ) ( 2-h glucose concentration > 7.8 mmol/1 ) was : 1.2 % at < 5 years , 5.4 % at 5–9 years , and 19.3 % at 10–16 years . The 88 offspring of diabetic mothers ( 12.3 ± 1.7 years ) , when compared with 80 control subjects of the same age and pubertal stage , had higher 2-h glucose ( 6.8 ±1.4 vs. 5.7 ± 0.9 mmol/1 , P < 0.001 ) and insulin ( 660 ± 720 vs. 455 ± 285 pmol/1 , P < 0.03 ) concentrations . The 17 subjects with IGT at > 10 years of age ( 9 boys and 8 girls ) include one girl with NIDDM . IGT was not associated with the etiology of the mother 's diabetes ( gestational versus pregestational ) or macrosomia at birth . IGT was found in only 3.7 % ( 1 of 27 ) of adolescents whose AFI was normal ( ≥100 pmol/l ) and 33.3 % ( 12 of 36 ) of those with elevated AFI ( P < 0.001 ) . Although most of the children with IGT are obese , AFI and obesity are independently associated with IGT by multiple logistic analysis . CONCLUSIONS In confirmation of our original hypothesis , IGT in the offspring is a long-term complication of maternal diabetes . Excessive insulin secretion in utero , as assessed by AFI concentration , is a strong predictor of IGT in childhood BACKGROUND Antenatal breast expression ( ABE ) has been taught in the past as breast preparation . Now some authorities are advising ABE and storage of colostrum for the feeding the newborn in the treatment and /or prevention of hypoglycaemia in the immediate postnatal period ( thus avoiding the need for formula supplementation ) . The actual incidence of ABE teaching amongst International Board Certified Lactation Consultant ( IBCLC ) Midwives is unknown . Results of this study will provide valuable baseline data for future r and omised controlled trials into this practice . RESEARCH QUESTION What are the teaching practice s surrounding ABE and the incidence of this type of teaching by IBCLC Midwives across Australia ? METHOD A descriptive cross-sectional Internet survey containing both quantitative and qualitative questions was sent to Australian IBCLC Midwives . Simple descriptive statistics was used to analyse quantitative data . Content analysis examined qualitative textual data of open-ended questions . FINDINGS Response rate was 27 % ( n=347/1269 ) . 93 % ( n=322 ) of those responding to the survey had heard of ABE . 60 % ( n=134 ) actively teach the practice . Descriptive statistics and content analysis revealed marked differences in teaching practice s amongst this specialised group of midwives . CONCLUSION This study suggested a large proportion of lactation qualified midwife respondents were aware of ABE and some currently teach the skill . However , advice given to women during pregnancy varied substantially Forster et al ( 2009 ) contend that the practice of recommending antenatal expressing and storing of colostrum by mothers with Type 1 diabetes should cease until its efficacy can be tested in a r and omised controlled trial ( RCT ) . This contention raises an ethical dilemma . The authors of the article conclude that considering that antenatal expression and storage of colostrum by pregnant Type 1 diabetic women gives their babies an extra amount of fluid that biochemically compares with colostrum if needed for hypoglycaemia , and that nipple stimulation has not been shown to induce labour , the practice should continue and women should be educated about this easy , positive and empowering practice The study evaluates breast stimulation and oxytocin infusion as methods for  cervical ripening in patients where an obstetric indication for induction of labour exists . Forty patients with a Bishop score of 5 or 6 were r and omly selected for either breast stimulation or oxytocin infusion . In a similar group of 20 cases , no method was employed . The Bishop score improved in 41.2 % of cases where breast stimulation was used as compared to 75 % where an oxytocin infusion was given . Three foetal deaths in the breast stimulation group brought the study to a stop after 17 cases . Cervical ripening with an  oxytocin infusion drip appears to be a better method since infusion dosage can be precisely controlled making the technique more predictable and reliable . Though breast stimulation is effective in ripening the cervix , it may be used only in cases of intrauterine foetal death as it may otherwise adversely affect foetal outcome This prospect i ve nationwide study conducted during 1982 - 1985 examined the rates of  hypertensive disorders , perinatal mortality and morbidity in 491 insulin-dependent diabetic pregnancies ( White 's classes : B , 164 ; C , 129 ; D , 172 ; F , 26 ) and in the total population of 279,000 . The rates of pregnancy-induced hypertension ( PIH ) or pre-eclampsia ( 20.6 % ) , premature delivery ( 24.6 % ) , and cesarean section ( 45.2 % ) in the diabetic group were more than four times higher than normal . PIH or preeclampsia occurred significantly ( p < 0.01 ) more frequently in patients with diabetic microangiopathy .  Mean birthweight was similar in the two population s but gestational age was significantly ( p < 0.001 ) shorter ( 38 weeks ) in the diabetic group . The rate of large for gestational age infants ( 20 % ) in the diabetic group was considerably above normal ( 3.5 % ) . Although perinatal mortality rate in the diabetic group was only 3.1 % , it was 4.4 times higher than normal ; five of ten fetal deaths were associated with poor glycemic control and thus may not really be unexplained . Neonatal morbidity was significantly more frequent in the diabetic group ; still , the incidence of idiopathic respiratory distress syndrome was only 1.6 % compared with 0.6 % in the general population . Discriminant analysis revealed that gestational age at birth and elevated maternal HbA1c values in early pregnancy independently of each other had a significant impact on the occurrence of neonatal morbidity OBJECTIVE infants of women with diabetes in pregnancy are at increased risk of hypoglycaemia . If the infant 's blood glucose is low and the mother is unable to breast feed/provide sufficient expressed breast milk , infants are often given formula . Some hospitals encourage women with diabetes to express breast milk before birth . However , there is limited evidence for this practice , including its impact on labour and birth , e.g. causing premature birth may be a concern . A pilot study was undertaken to establish the feasibility of conducting an adequately powered r and omised controlled trial to evaluate this practice . DESIGN consecutive eligible women with pre-existing or gestational diabetes ( requiring insulin ) , planning to breast feed and attending the study hospital were offered participation . INCLUSION CRITERIA 34 - 36 weeks of gestation ; singleton pregnancy ; cephalic presentation ; and able to speak , read and write in English . EXCLUSION CRITERIA history of spontaneous preterm birth , antepartum haemorrhage , placenta praevia and suspected fetal compromise . Women were encouraged to express colostrum twice a day from 36 weeks of gestation , and advised how to store the colostrum , which was frozen for their infant 's use after birth . They were asked to keep a diary documenting their expressing . DATA demographic question naire , telephone interview at six and 12 weeks postpartum and medical record data . SETTING a public , tertiary , women 's hospital in Melbourne , Australia . PARTICIPANTS 43 women with diabetes in pregnancy ( requiring insulin ) . FINDINGS cardiotocographs were undertaken after the first expressing episode and none of the infants showed any sign of fetal compromise . Forty per cent of infants received formula in the 24 hours postpartum . The proportion of infants receiving any breast milk at six weeks was 90 % , and this decreased to 75 % at 12 weeks . No women showed evidence of hypoglycaemia post expressing . The intervention was positively received by most women ; 95 % said that they would express antenatally again if the practice proved to be beneficial . The amount of colostrum varied according to the number of expressions , the length of time in 
    Output:
    