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 Overweight and obesity is a significant health concern during pregnancy . Our aim was to investigate the effect of providing antenatal dietary and lifestyle advice to women who are overweight or obese on components of maternal diet and physical activity . Methods We conducted a r and omised controlled trial , in which pregnant women with a body mass index ≥25 kg/m2 , and singleton gestation between 10 + 0 to 20 + 0 weeks were recruited and r and omised to Lifestyle Advice ( involving a comprehensive dietary and lifestyle intervention over their pregnancy ) or St and ard Care . Within the intervention group , we conducted a nested r and omised trial in which a subgroup of women were further r and omised to receive access to supervised group walking sessions in addition to the st and ard information presented during the intervention contacts ( the Walking group ) or st and ard information only . The outcome measures were maternal dietary intake , ( including food groups , macronutrient and micronutrient intake , diet quality ( using the Healthy Eating Index ; HEI ) , dietary glycaemic load , and glycaemic index ) and maternal physical activity . Women completed the Harvard Semi-Structured Food Frequency Question naire , and the Short Question naire to Assess Health-enhancing Physical Activity ( SQUASH ) , at trial entry , 28 and 36 weeks ’ gestational age , and 4 months postpartum . Analyses were performed on an intention-to-treat basis , using linear mixed effects models with adjustment for the stratification variables . Results Women r and omised to Lifestyle Advice demonstrated a statistically significant increase in the number of servings of fruit and vegetables consumed per day , as well as increased consumption of fibre , and reduced percentage energy intake from saturated fats ( P < 0.05 for all ) . Maternal HEI was significantly improved at both 28 ( 73.35 ± 6.62 versus 71.86 ± 7.01 ; adjusted difference in means 1.58 ; 95 % CI 0.89 to 2.27 ; P < 0.0001 ) and 36 ( 72.95 ± 6.82 versus 71.17 ± 7.69 ; adjusted difference in means 1.77 ; 95 % CI 1.01 to 2.53 ; P < 0.0001 ) weeks . There were no differences in dietary glycaemic index or glycaemic load . Women r and omised to Lifestyle Advice also demonstrated greater total physical activity ( adjusted difference in means 359.76 metabolic equivalent task units ( MET ) minutes/week ; 95 % CI 74.87 to 644.65 ; P = 0.01 ) compared with women receiving St and ard Care . The supervised walking group was poorly utilised . Conclusions For women who are overweight or obese , antenatal lifestyle advice improves maternal diet and physical activity during pregnancy . Please see related articles : http://www.biomed central .com/1741 - 7015/12/163 and http://www.biomed central .com/1741 - 7015/12/201.Trial registration Australian and New Zeal and Clinical Trials Registry ( http://ACTRN12607000161426 Background Obesity is a significant global health problem , with the proportion of women entering pregnancy with a body mass index greater than or equal to 25 kg/m2 approaching 50 % . Obesity during pregnancy is associated with a well-recognised increased risk of adverse health outcomes both for the woman and her infant , however there is more limited information available regarding effective interventions to improve health outcomes .The aims of this r and omised controlled trial are to assess whether the implementation of a package of dietary and lifestyle advice to overweight and obese women during pregnancy to limit gestational weight gain is effective in improving maternal , fetal and infant health outcomes . Methods / Design Design : Multicentred r and omised , controlled trial . Inclusion Criteria : Women with a singleton , live gestation between 10 + 0 - 20 + 0 weeks who are obese or overweight ( defined as body mass index greater than or equal to 25 kg/m2 ) , at the first antenatal visit . Trial Entry & R and omisation : Eligible , consenting women will be r and omised between 10 + 0 and 20 + 0 weeks gestation using a central telephone r and omisation service , and r and omisation schedule prepared by non- clinical research staff with balanced variable blocks . Stratification will be according to maternal BMI at trial entry , parity , and centre where planned to give birth . Treatment Schedules : Women r and omised to the Dietary and Lifestyle Advice Group will receive a series of inputs from research assistants and research dietician to limit gestational weight gain , and will include a combination of dietary , exercise and behavioural strategies .  Women r and omised to the St and ard Care Group will continue to receive their pregnancy care according to local hospital guidelines , which does not currently include routine provision of dietary , lifestyle and behavioural advice . Outcome assessors will be blinded to the allocated treatment group . Primary Study Outcome : infant large for gestational age ( defined as infant birth weight ≥ 90th centile for gestational age ) . Sample Size : 2,180 women to detect a 30 % reduction in large for gestational age infants from 14.40 % ( p = 0.05 , 80 % power , two-tailed ) . Discussion This is a protocol for a r and omised trial . The findings will contribute to the development of evidence based clinical practice guidelines .Trial Registration Australian and New Zeal and Clinical Trials Registry Background Gestational Diabetes Mellitus ( GDM ) has well recognised adverse health implication s for the mother and her newborn that are both short and long term . Obesity is a significant risk factor for developing GDM and the prevalence of obesity is increasing globally . It is a matter of public health importance that clinicians have evidence based strategies to inform practice and currently there is insufficient evidence regarding the impact of dietary and lifestyle interventions on improving maternal and newborn outcomes . The primary aim of this study is to measure the impact of a telephone based intervention  that promotes positive lifestyle modifications on the incidence of GDM . Secondary aims include : the impact on gestational weight gain ; large for gestational age babies ; differences in blood glucose levels taken at the Oral Glucose Tolerance Test ( OGTT ) and selected factors relating to self-efficacy and psychological wellbeing . Method / design A r and omised controlled trial ( RCT ) will be conducted involving pregnant women who are overweight ( BMI > 25 to 29.9 k/gm2 ) or obese ( BMI > 30 kgm/2 ) , less than 14 weeks gestation and recruited from the Barwon South West region of Victoria , Australia . From recruitment until birth , women in the intervention group will receive a program informed by the Theory of Self-efficacy and employing Motivational Interviewing . Brief ( less than 5 minute ) phone contact will alternate with a text message/email and will involve goal setting , behaviour change reinforcement with weekly weighing and charting , and the provision of health information . Those in the control group will receive usual care . Data for primary and secondary outcomes will be collected from medical record review and a question naire at 36 weeks gestation . Discussion Evidence based strategies that reduce the incidence of GDM are a priority for contemporary maternity care . Changing health behaviours is a complex undertaking and trialling a composite intervention that can be adopted in various primary health setting s is required so women can be accessed as early in pregnancy as possible . Using a sound theoretical base to inform such an intervention will add depth to our underst and ing of this approach and to the interpretation of results , contributing to the evidence base for practice and policy . Trial registration This trial is registered with the Australian New Zeal and Clinical Trials Registry ( ANZCTR ) : Objective The study was to examine whether gestational diabetes mellitus ( GDM ) can be prevented by early trimester lifestyle counseling in a high-risk population . Methods From September 2012 to January 2013 , 1664 pregnancies in the Department of Obstetrics and Gynecology of First Hospital of Peking University were enrolled in the study during their first prenatal care visit before the 8 gestational weeks visit and asked to fill out a question naire on GDM risk evaluation . According to the question naire and medical records , those with at least one risk factor of GDM were included in the intervention study and r and omly allocated to two groups , intervention group and control group . Routine prenatal care was offered , while st and ardized two-step lifestyle intervention was provided to the intervention group during 6–8 gestational weeks , and at 12–13 gestational weeks , enforcement intervention based on maternal anthropometrics were offered . Both groups were followed until 75 g oral glucose tolerance test ( OGTT ) testing at 24–28 gestational weeks . The weight gain after intervention and the prevalence of GDM were used to evaluate the effect . Results ( 1 ) According to the International Association of Diabetes and Pregnancy Study Groups ( IADPSG ) criteria , the positive rate of GDM for the intervention group was 17.16 % ( 23/134 ) , lower than the control group which was 23.91 % ( 33/138 ) , P = 0.168 . ( 2 ) The weight gain during the first and second trimester for the intervention group was ( 1.38 ± 2.34 ) kg and ( 5.51 ± 2.18 ) kg , lower than in the control group which was ( 1.41 ± 2.58 ) kg and ( 5.66 ± 2.25 ) kg , ( P = 0.905 , P = 0.567 ) . ( 3 ) Positive rate of GDM for those fasting plasma glucose ( FPG ) ≥5.1 mmol/L during early pregnancy was 11/36 ( 30.55 % ) for the intervention group that was lower than 17/37 ( 45.95 % ) for the control group , but the statistical difference was not significant ( P = 0.076 ) . Conclusion The positive rate of GDM could be reduced by a certain amount lifestyle intervention from the beginning of pregnancy . More vali date d effective intervention should be explored in the high-risk pregnant women Background The costs of gestational diabetes mellitus ( GDM ) screening have been frequently reported , but total GDM-related health care costs compared to the health care costs of women without GDM have not been reported . The aim of this study was to analyse GDM-related health care costs among women with an elevated risk of GDM . Methods The study was based on a cluster-r and omised GDM prevention trial ( N = 848 ) carried out at maternity clinics , combined with data from the Finnish Medical Birth Register and Care Registers for Social Welfare and Health Care . Costs of outpatient visits to primary and secondary care , cost of inpatient hospital care before and after delivery , the use of insulin , delivery costs and babies ’ stay in the neonatal intensive care unit were analysed . Women who developed GDM were compared to those who were not diagnosed with GDM . Results Total mean health care costs adjusted for age , body mass index and education were 25.1 % higher among women diagnosed with GDM ( € 6,432 vs. € 5,143 , p < 0.001 ) than among women without GDM . The cost of inpatient visits was 44 % higher and neonatal intensive care unit use was 49 % higher in the GDM group than among women without GDM . The delivery costs were the largest single component in both groups . Conclusions A confirmed GDM diagnosis was associated with a significant increase in total health care costs . Effective lifestyle counselling by primary health care providers may offer a means of reducing the high costs of secondary care Objective In obese women , 1 ) to assess whether lower gestational weight gain ( GWG ) during pregnancy in the lifestyle intervention group of a r and omized controlled trial ( RCT ) result ed in differences in offspring anthropometrics and body composition , and 2 ) to compare offspring outcomes to a reference group of children born to women with a normal Body Mass Index ( BMI ) . Research design and methods The LiPO ( Lifestyle in Pregnancy and Offspring ) study was an offspring follow-up of a RCT with 360 obese pregnant women with a lifestyle intervention during pregnancy including dietary advice , coaching and exercise .  The trial was completed by 301 women who were eligible for follow-up . In addition , to the children from the RCT , a group of children born to women with a normal BMI were included as a reference group . At 2.8 ( range 2.5–3.2 ) years , anthropometrics were measured in 157 children of the RCT mothers and in 97 reference group children with Body Mass Index ( BMI ) Z-score as a primary outcome . Body composition was estimated by Dual Energy X-ray ( DEXA ) in 123 successful scans out of 147 ( 84 % ) . Results No differences between r and omized groups were seen in mean ( 95 % C.I. ) BMI Z-score ( intervention group 0.06 [ −0.17 ; 0.29 ] vs. controls −0.18 [ −0.43 ; 0.05 ] ) , in the percentage of overweight or obese children ( 10.9 % vs. 6.7 % ) , in other anthropometrics , or in body composition values by DEXA . Outcomes between children from the RCT and the reference group children were not significantly different . Conclusions The RCT with lifestyle intervention in obese pregnant women did not result in any detectable effect on offspring anthropometrics or body composition by DEXA at  
    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 Overweight and obesity is a significant health concern during pregnancy . Our aim was to investigate the effect of providing antenatal dietary and lifestyle advice to women who are overweight or obese on components of maternal diet and physical activity . Methods We conducted a r and omised controlled trial , in which pregnant women with a body mass index ≥25 kg/m2 , and singleton gestation between 10 + 0 to 20 + 0 weeks were recruited and r and omised to Lifestyle Advice ( involving a comprehensive dietary and lifestyle intervention over their pregnancy ) or St and ard Care . Within the intervention group , we conducted a nested r and omised trial in which a subgroup of women were further r and omised to receive access to supervised group walking sessions in addition to the st and ard information presented during the intervention contacts ( the Walking group ) or st and ard information only . The outcome measures were maternal dietary intake , ( including food groups , macronutrient and micronutrient intake , diet quality ( using the Healthy Eating Index ; HEI ) , dietary glycaemic load , and glycaemic index ) and maternal physical activity . Women completed the Harvard Semi-Structured Food Frequency Question naire , and the Short Question naire to Assess Health-enhancing Physical Activity ( SQUASH ) , at trial entry , 28 and 36 weeks ’ gestational age , and 4 months postpartum . Analyses were performed on an intention-to-treat basis , using linear mixed effects models with adjustment for the stratification variables . Results Women r and omised to Lifestyle Advice demonstrated a statistically significant increase in the number of servings of fruit and vegetables consumed per day , as well as increased consumption of fibre , and reduced percentage energy intake from saturated fats ( P < 0.05 for all ) . Maternal HEI was significantly improved at both 28 ( 73.35 ± 6.62 versus 71.86 ± 7.01 ; adjusted difference in means 1.58 ; 95 % CI 0.89 to 2.27 ; P < 0.0001 ) and 36 ( 72.95 ± 6.82 versus 71.17 ± 7.69 ; adjusted difference in means 1.77 ; 95 % CI 1.01 to 2.53 ; P < 0.0001 ) weeks . There were no differences in dietary glycaemic index or glycaemic load . Women r and omised to Lifestyle Advice also demonstrated greater total physical activity ( adjusted difference in means 359.76 metabolic equivalent task units ( MET ) minutes/week ; 95 % CI 74.87 to 644.65 ; P = 0.01 ) compared with women receiving St and ard Care . The supervised walking group was poorly utilised . Conclusions For women who are overweight or obese , antenatal lifestyle advice improves maternal diet and physical activity during pregnancy . Please see related articles : http://www.biomed central .com/1741 - 7015/12/163 and http://www.biomed central .com/1741 - 7015/12/201.Trial registration Australian and New Zeal and Clinical Trials Registry ( http://ACTRN12607000161426 Background Obesity is a significant global health problem , with the proportion of women entering pregnancy with a body mass index greater than or equal to 25 kg/m2 approaching 50 % . Obesity during pregnancy is associated with a well-recognised increased risk of adverse health outcomes both for the woman and her infant , however there is more limited information available regarding effective interventions to improve health outcomes .The aims of this r and omised controlled trial are to assess whether the implementation of a package of dietary and lifestyle advice to overweight and obese women during pregnancy to limit gestational weight gain is effective in improving maternal , fetal and infant health outcomes . Methods / Design Design : Multicentred r and omised , controlled trial . Inclusion Criteria : Women with a singleton , live gestation between 10 + 0 - 20 + 0 weeks who are obese or overweight ( defined as body mass index greater than or equal to 25 kg/m2 ) , at the first antenatal visit . Trial Entry & R and omisation : Eligible , consenting women will be r and omised between 10 + 0 and 20 + 0 weeks gestation using a central telephone r and omisation service , and r and omisation schedule prepared by non- clinical research staff with balanced variable blocks . Stratification will be according to maternal BMI at trial entry , parity , and centre where planned to give birth . Treatment Schedules : Women r and omised to the Dietary and Lifestyle Advice Group will receive a series of inputs from research assistants and research dietician to limit gestational weight gain , and will include a combination of dietary , exercise and behavioural strategies .  Women r and omised to the St and ard Care Group will continue to receive their pregnancy care according to local hospital guidelines , which does not currently include routine provision of dietary , lifestyle and behavioural advice . Outcome assessors will be blinded to the allocated treatment group . Primary Study Outcome : infant large for gestational age ( defined as infant birth weight ≥ 90th centile for gestational age ) . Sample Size : 2,180 women to detect a 30 % reduction in large for gestational age infants from 14.40 % ( p = 0.05 , 80 % power , two-tailed ) . Discussion This is a protocol for a r and omised trial . The findings will contribute to the development of evidence based clinical practice guidelines .Trial Registration Australian and New Zeal and Clinical Trials Registry Background Gestational Diabetes Mellitus ( GDM ) has well recognised adverse health implication s for the mother and her newborn that are both short and long term . Obesity is a significant risk factor for developing GDM and the prevalence of obesity is increasing globally . It is a matter of public health importance that clinicians have evidence based strategies to inform practice and currently there is insufficient evidence regarding the impact of dietary and lifestyle interventions on improving maternal and newborn outcomes . The primary aim of this study is to measure the impact of a telephone based intervention  that promotes positive lifestyle modifications on the incidence of GDM . Secondary aims include : the impact on gestational weight gain ; large for gestational age babies ; differences in blood glucose levels taken at the Oral Glucose Tolerance Test ( OGTT ) and selected factors relating to self-efficacy and psychological wellbeing . Method / design A r and omised controlled trial ( RCT ) will be conducted involving pregnant women who are overweight ( BMI > 25 to 29.9 k/gm2 ) or obese ( BMI > 30 kgm/2 ) , less than 14 weeks gestation and recruited from the Barwon South West region of Victoria , Australia . From recruitment until birth , women in the intervention group will receive a program informed by the Theory of Self-efficacy and employing Motivational Interviewing . Brief ( less than 5 minute ) phone contact will alternate with a text message/email and will involve goal setting , behaviour change reinforcement with weekly weighing and charting , and the provision of health information . Those in the control group will receive usual care . Data for primary and secondary outcomes will be collected from medical record review and a question naire at 36 weeks gestation . Discussion Evidence based strategies that reduce the incidence of GDM are a priority for contemporary maternity care . Changing health behaviours is a complex undertaking and trialling a composite intervention that can be adopted in various primary health setting s is required so women can be accessed as early in pregnancy as possible . Using a sound theoretical base to inform such an intervention will add depth to our underst and ing of this approach and to the interpretation of results , contributing to the evidence base for practice and policy . Trial registration This trial is registered with the Australian New Zeal and Clinical Trials Registry ( ANZCTR ) : Objective The study was to examine whether gestational diabetes mellitus ( GDM ) can be prevented by early trimester lifestyle counseling in a high-risk population . Methods From September 2012 to January 2013 , 1664 pregnancies in the Department of Obstetrics and Gynecology of First Hospital of Peking University were enrolled in the study during their first prenatal care visit before the 8 gestational weeks visit and asked to fill out a question naire on GDM risk evaluation . According to the question naire and medical records , those with at least one risk factor of GDM were included in the intervention study and r and omly allocated to two groups , intervention group and control group . Routine prenatal care was offered , while st and ardized two-step lifestyle intervention was provided to the intervention group during 6–8 gestational weeks , and at 12–13 gestational weeks , enforcement intervention based on maternal anthropometrics were offered . Both groups were followed until 75 g oral glucose tolerance test ( OGTT ) testing at 24–28 gestational weeks . The weight gain after intervention and the prevalence of GDM were used to evaluate the effect . Results ( 1 ) According to the International Association of Diabetes and Pregnancy Study Groups ( IADPSG ) criteria , the positive rate of GDM for the intervention group was 17.16 % ( 23/134 ) , lower than the control group which was 23.91 % ( 33/138 ) , P = 0.168 . ( 2 ) The weight gain during the first and second trimester for the intervention group was ( 1.38 ± 2.34 ) kg and ( 5.51 ± 2.18 ) kg , lower than in the control group which was ( 1.41 ± 2.58 ) kg and ( 5.66 ± 2.25 ) kg , ( P = 0.905 , P = 0.567 ) . ( 3 ) Positive rate of GDM for those fasting plasma glucose ( FPG ) ≥5.1 mmol/L during early pregnancy was 11/36 ( 30.55 % ) for the intervention group that was lower than 17/37 ( 45.95 % ) for the control group , but the statistical difference was not significant ( P = 0.076 ) . Conclusion The positive rate of GDM could be reduced by a certain amount lifestyle intervention from the beginning of pregnancy . More vali date d effective intervention should be explored in the high-risk pregnant women Background The costs of gestational diabetes mellitus ( GDM ) screening have been frequently reported , but total GDM-related health care costs compared to the health care costs of women without GDM have not been reported . The aim of this study was to analyse GDM-related health care costs among women with an elevated risk of GDM . Methods The study was based on a cluster-r and omised GDM prevention trial ( N = 848 ) carried out at maternity clinics , combined with data from the Finnish Medical Birth Register and Care Registers for Social Welfare and Health Care . Costs of outpatient visits to primary and secondary care , cost of inpatient hospital care before and after delivery , the use of insulin , delivery costs and babies ’ stay in the neonatal intensive care unit were analysed . Women who developed GDM were compared to those who were not diagnosed with GDM . Results Total mean health care costs adjusted for age , body mass index and education were 25.1 % higher among women diagnosed with GDM ( € 6,432 vs. € 5,143 , p < 0.001 ) than among women without GDM . The cost of inpatient visits was 44 % higher and neonatal intensive care unit use was 49 % higher in the GDM group than among women without GDM . The delivery costs were the largest single component in both groups . Conclusions A confirmed GDM diagnosis was associated with a significant increase in total health care costs . Effective lifestyle counselling by primary health care providers may offer a means of reducing the high costs of secondary care Objective In obese women , 1 ) to assess whether lower gestational weight gain ( GWG ) during pregnancy in the lifestyle intervention group of a r and omized controlled trial ( RCT ) result ed in differences in offspring anthropometrics and body composition , and 2 ) to compare offspring outcomes to a reference group of children born to women with a normal Body Mass Index ( BMI ) . Research design and methods The LiPO ( Lifestyle in Pregnancy and Offspring ) study was an offspring follow-up of a RCT with 360 obese pregnant women with a lifestyle intervention during pregnancy including dietary advice , coaching and exercise .  The trial was completed by 301 women who were eligible for follow-up . In addition , to the children from the RCT , a group of children born to women with a normal BMI were included as a reference group . At 2.8 ( range 2.5–3.2 ) years , anthropometrics were measured in 157 children of the RCT mothers and in 97 reference group children with Body Mass Index ( BMI ) Z-score as a primary outcome . Body composition was estimated by Dual Energy X-ray ( DEXA ) in 123 successful scans out of 147 ( 84 % ) . Results No differences between r and omized groups were seen in mean ( 95 % C.I. ) BMI Z-score ( intervention group 0.06 [ −0.17 ; 0.29 ] vs. controls −0.18 [ −0.43 ; 0.05 ] ) , in the percentage of overweight or obese children ( 10.9 % vs. 6.7 % ) , in other anthropometrics , or in body composition values by DEXA . Outcomes between children from the RCT and the reference group children were not significantly different . Conclusions The RCT with lifestyle intervention in obese pregnant women did not result in any detectable effect on offspring anthropometrics or body composition by DEXA at  
    Output:
    