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: OBJECTIVE To minimise obese women 's total weight gain during pregnancy to less than 7 kg and to investigate the delivery and neonatal outcome . DESIGN A prospect i ve case-control intervention study . SETTING Antenatal care clinics in the southeast region of Sweden . POPULATION One hundred fifty-five pregnant women in an index group and one hundred ninety-three women in a control group . METHODS An intervention programme with weekly motivational talks and aqua aerobic classes for obese pregnant women . MAIN OUTCOME MEASURES Weight gain in kilograms , delivery and neonatal outcome . RESULTS The index group had a significantly lower weight gain during pregnancy compared with the control group ( P < 0.001 ) . The women in the index group weighed less at the postnatal check-up compared with the weight registered in early pregnancy ( P < 0.001 ) . The percentage of women in the index group who gained less than 7 kg was greater than that of women in the control group who gained less than 7 kg ( P= 0.003 ) . The percentage of nulliparous women  in this group was greater than that in the control group ( P= 0.018 ) . In addition , the women in the index group had a significantly lower body mass index at the postnatal check-up , compared with the control group ( P < 0.001 ) . There were no differences between the index group and the control group regarding birthweight , gestational age and mode of delivery . CONCLUSION The intervention programme was effective in controlling weight gain during pregnancy and did not affect delivery or neonatal outcome AIM The significant deterioration of insulin sensitivity and glucose tolerance during pregnancy can have serious health implication s for both the pregnant woman and her baby . Although it is well established that regular exercise benefits insulin sensitivity in the nonpregnant population , the effect on glucose tolerance in obese pregnant women is not known . The purpose of this study was to investigate the effect of a supervised 10-week , home-based , exercise programme , beginning at week 18 of gestation , on glucose tolerance and aerobic fitness in previously sedentary obese women . METHODS Twelve sedentary obese women were r and omized into an exercise ( EX ; n=6 ) or control ( CON ; n=6 ) group at 18 weeks of gestation . Those r and omized to EX engaged in 10 weeks of supervised home-based exercise ( three sessions a week of stationary cycling ) , while those in the CON group maintained their usual daily activity . Their glucose and insulin responses to an oral glucose tolerance test ( OGTT ) , as well as their aerobic fitness , were assessed both pre- and postintervention . RESULTS Reduced glucose tolerance in the CON , but not EX , group was indicated by a tendency postintervention towards higher blood glucose levels at 1h of the OGTT ( P=0.072 ) . Furthermore , at 2h of the postintervention OGTT , blood glucose tended to remain elevated from baseline in the CON ( P=0.077 ) . There was also a trend towards increased fitness in the EX ( P=0.064 ) , but not the CON group . CONCLUSION Regular aerobic exercise begun during pregnancy may have favourable effects on glucose tolerance and fitness in obese women , and warrants further investigation in a larger sample population OBJECTIVE : To estimate whether an organized , consistent program of dietary and lifestyle counseling prevents excessive weight gain  in pregnancy . METHODS : This r and omized controlled trial assigned women to receive either an organized , consistent program of intensive dietary and lifestyle counseling or routine prenatal care . The primary study outcome was the proportion of patients whose gestational weight gain was within the Institute of Medicine ( IOM ) guidelines . Secondary outcomes included mode of delivery , rate of operative vaginal delivery , neonatal weight , and the incidence of preeclampsia , gestational diabetes mellitus ( GDM ) , vaginal/perineal lacerations , and shoulder dystocia . RESULTS : A total of 100 women were r and omized to the study ( lifestyle counseling 57 , routine prenatal care 43 ) . Baseline demographic characteristics were similar between the study groups . The lifestyle counseling group gained significantly less weight than did the routine prenatal care group ( 28.7±12.5 lb compared with 35.6±15.5 lb , P=.01 ) . The routine prenatal care group had significantly more cesarean deliveries due to “ failure to progress ” ( routine prenatal care 58.3 % compared with lifestyle counseling 25.0 % , P=.02 ) . Across groups , patients who were not adherent to the IOM guidelines had significantly heavier neonates ( adherent 3,203.2±427.2 g compared with not adherent 3,517.4±572.4 g , P<.01 ) . Nulliparous women  gained significantly more weight than did parous women ( 36.5±14.5 lb compared with 27.7±12.7 lb , P<.01 ) . The most predictive factor of IOM adherence was having a normal prepregnancy body mass index . No statistically significant differences were noted between the groups in adherence to IOM guidelines , rate of cesarean delivery , preeclampsia , GDM , operative vaginal delivery , or vaginal lacerations . CONCLUSION : An organized , consistent program of dietary and lifestyle counseling did reduce weight gain in pregnancy . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00792480 LEVEL OF EVIDENCE : Objective The influence of an exercise programme performed by healthy pregnant women on maternal glucose tolerance was studied . Study design A physical activity ( PA , l and /aquatic activities ) programme during the entire pregnancy ( three sessions per week ) was conducted by a qualified instructor . 83 healthy pregnant women were r and omly assigned to either an exercise group ( EG , n=40 ) or a control ( CG , n=43 ) group . 50 g maternal glucose screen ( MGS ) , maternal weight gain and several pregnancy outcomes were recorded . Results Significant differences were found between study groups on the 50 g MGS . Values corresponding to the EG ( 103.8±20.4 mg/dl ) were better than those of the CG ( 126.9±29.5 mg/dl ) , p=0.000 . In addition , no differences in maternal weight gain and no cases of gestational diabetes in EG versus 3 in CG ( 7 % ) ( p>0.05 ) were found . Conclusion A moderate PA programme performed during pregnancy improves levels of maternal glucose tolerance Background Excessive gestational weight gain and postpartum weight retention may predispose women to long-term overweight and other health problems . Intervention studies aim ing at preventing excessive pregnancy-related weight gain are needed . The feasibility of implementing such a study protocol in primary health care setting was evaluated in this pilot study . Methods A non-r and omized controlled trial was conducted in three intervention and three control maternity and child health clinics in primary health care in Finl and . Altogether , 132 pregnant and 92 postpartum women and 23 public health nurses ( PHN ) participated in the study . The intervention consisted of individual counselling on physical activity and diet at five routine visits to a PHN and of an option for supervised group exercise until 37 weeks ' gestation or ten months postpartum . The control clinics continued their usual care . The components of the feasibility evaluation were 1 ) recruitment and participation , 2 ) completion of data collection , 3 ) realization of the intervention and 4 ) the public health nurses ' experiences . Results 1 ) The recruitment rate was slower than expected and the recruitment period had to be prolonged from the initially planned three months to six months . The average participation rate of eligible women at study enrolment was 77 % and the drop-out rate 15 % . 2 ) In total , 99 % of the data on weight , physical activity and diet and 96 % of the blood sample s were obtained . 3 ) In the intervention clinics , 98 % of the counselling sessions were realized , their contents and average duration s were as intended , 87 % of participants regularly completed the weekly records for physical activity and diet , and the average participation percentage in the group exercise sessions was 45 % . 4 ) The PHNs regarded the extra training as a major advantage and the high additional workload as a disadvantage of the study . Conclusion The study protocol was mostly feasible to implement , which encourages conducting large trials in comparable setting s . Trial registration Current Controlled Trials IS RCT Obesity among pregnant women is becoming one of the most important women 's health issues . Obesity is associated with increased risk of almost all pregnancy complications : gestational hypertension , preeclampsia , gestational diabetes mellitus , delivery of large-for-GA infants , and higher incidence of congenital defects all occur more frequently than in women with a normal BMI . Evidence shows that a child of an obese mother may suffer from exposure to a suboptimal in utero environment and that early life adversities may extend into adulthood . In September 2009 , ILSI Europe convened a workshop with multidisciplinary expertise to review practice s and science base of health and nutrition of obese pregnant women , with focus on the long-term health of the child . The consensus viewpoint of the workshop identified gaps and gave recommendations for future research on gestational weight gain , gestational diabetes , and research method ologies . The evidence available on short- and long-term health impact for mother and child currently favors actions directed at controlling prepregnancy weight and preventing obesity in women of reproductive ages . More r and omized controlled trials are needed to evaluate the effects of nutritional and behavioral interventions in pregnancy outcomes . Moreover , suggestions that maternal obesity may transfer obesity risk to child through non-Mendelian ( e.g. epigenetic ) mechanisms require more long-term investigation Objective To examine the extent to which women planning a pregnancy comply with recommendations for nutrition and lifestyle . Design Prospect i ve cohort study . Setting Southampton , United Kingdom . Participants 12 445 non-pregnant women aged 20 - 34 recruited to the Southampton Women ’s Survey through general practice s , 238 of whom became pregnant within three months of being interviewed . Main outcome measures Folic acid supplement intake , alcohol consumption , smoking , diet , and physical activity before pregnancy . Results The 238 women who became pregnant within three months of the interview were only marginally more likely to comply with recommendations for those planning a pregnancy than those who did not become pregnant in this period . Among those who became pregnant , 2.9 % ( 95 % confidence interval 1.2 % to 6.0 % ) were taking 400 μg or more of folic acid supplements  a day and drinking four or fewer units of alcohol a week , compared with 0.66 % ( 0.52 % to 0.82 % ) of those who did not become pregnant . 74 % of those who became pregnant were non-smokers compared with 69 % of those who did not become pregnant ( P=0.08 ) . Women in both groups were equally likely to consume five or more portions of fruit and vegetables a day ( 53 % in each group , P=1.0 ) , but only 57 % of those who became pregnant had taken any strenuous exercise in the past three months compared with 64 % in those who did not become pregnant ( P=0.03 ) . Conclusion Only a small proportion of women planning a pregnancy follow the recommendations for nutrition and lifestyle . Greater publicity for the recommendations is needed , but as many pregnancies are unplanned , improved nutrition and lifestyles of women of childbearing age is also required BACKGROUND Although obesity in pregnancy continues to be associated with ongoing health problems , many clinicians have been reluctant to place nondiabetic , obese , pregnant women on a monitored , calorie-appropriate nutritional regimen for fear of fetal growth restriction , low birth weight , or starvation ketosis . METHODS A total of 257 patients were enrolled in the r and omized study , with a loss-to-follow-up rate of 9.73 % . Patients were assigned r and omly to either the control ( unmonitored ) group ( n=116 ) , consisting of conventional prenatal dietary management , or to the study ( monitored ) group ( n=116 ) , which was prescribed a balanced nutritional regimen and were asked to record in a diary all of the foods eaten during each day .  Women were eligible for the study if they were pregnant with a single fetus between 12 and 28 weeks of gestation and had a prepregnancy body mass index of more than 30 kg/m2 . The primary outcome was to compare perinatal outcomes in the control vs the study groups . The secondary measure was to compare outcomes in adherent and nonadherent patients in the study group . RESULTS Omnibus MANOVA showed statistically significant differences between the study and control groups regarding 3 variables : ( 1 ) gestational hypertension , p < .46 ; ( 2 ) mother 's last weight before delivery , p < .001 ; and ( 3 ) mother 's 6-week postpartum weight , p < .001 . Patients gaining 15 pounds or more during their pregnancy showed statistically significant differences between the groups for 8 variables . CONCLUSION Obese pregnant women may be placed on a healthy , well-balanced , monitored nutritional program during their antepartum course without adverse perinatal outcomes BACKGROUND Maternal obesity and 
    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: OBJECTIVE To minimise obese women 's total weight gain during pregnancy to less than 7 kg and to investigate the delivery and neonatal outcome . DESIGN A prospect i ve case-control intervention study . SETTING Antenatal care clinics in the southeast region of Sweden . POPULATION One hundred fifty-five pregnant women in an index group and one hundred ninety-three women in a control group . METHODS An intervention programme with weekly motivational talks and aqua aerobic classes for obese pregnant women . MAIN OUTCOME MEASURES Weight gain in kilograms , delivery and neonatal outcome . RESULTS The index group had a significantly lower weight gain during pregnancy compared with the control group ( P < 0.001 ) . The women in the index group weighed less at the postnatal check-up compared with the weight registered in early pregnancy ( P < 0.001 ) . The percentage of women in the index group who gained less than 7 kg was greater than that of women in the control group who gained less than 7 kg ( P= 0.003 ) . The percentage of nulliparous women  in this group was greater than that in the control group ( P= 0.018 ) . In addition , the women in the index group had a significantly lower body mass index at the postnatal check-up , compared with the control group ( P < 0.001 ) . There were no differences between the index group and the control group regarding birthweight , gestational age and mode of delivery . CONCLUSION The intervention programme was effective in controlling weight gain during pregnancy and did not affect delivery or neonatal outcome AIM The significant deterioration of insulin sensitivity and glucose tolerance during pregnancy can have serious health implication s for both the pregnant woman and her baby . Although it is well established that regular exercise benefits insulin sensitivity in the nonpregnant population , the effect on glucose tolerance in obese pregnant women is not known . The purpose of this study was to investigate the effect of a supervised 10-week , home-based , exercise programme , beginning at week 18 of gestation , on glucose tolerance and aerobic fitness in previously sedentary obese women . METHODS Twelve sedentary obese women were r and omized into an exercise ( EX ; n=6 ) or control ( CON ; n=6 ) group at 18 weeks of gestation . Those r and omized to EX engaged in 10 weeks of supervised home-based exercise ( three sessions a week of stationary cycling ) , while those in the CON group maintained their usual daily activity . Their glucose and insulin responses to an oral glucose tolerance test ( OGTT ) , as well as their aerobic fitness , were assessed both pre- and postintervention . RESULTS Reduced glucose tolerance in the CON , but not EX , group was indicated by a tendency postintervention towards higher blood glucose levels at 1h of the OGTT ( P=0.072 ) . Furthermore , at 2h of the postintervention OGTT , blood glucose tended to remain elevated from baseline in the CON ( P=0.077 ) . There was also a trend towards increased fitness in the EX ( P=0.064 ) , but not the CON group . CONCLUSION Regular aerobic exercise begun during pregnancy may have favourable effects on glucose tolerance and fitness in obese women , and warrants further investigation in a larger sample population OBJECTIVE : To estimate whether an organized , consistent program of dietary and lifestyle counseling prevents excessive weight gain  in pregnancy . METHODS : This r and omized controlled trial assigned women to receive either an organized , consistent program of intensive dietary and lifestyle counseling or routine prenatal care . The primary study outcome was the proportion of patients whose gestational weight gain was within the Institute of Medicine ( IOM ) guidelines . Secondary outcomes included mode of delivery , rate of operative vaginal delivery , neonatal weight , and the incidence of preeclampsia , gestational diabetes mellitus ( GDM ) , vaginal/perineal lacerations , and shoulder dystocia . RESULTS : A total of 100 women were r and omized to the study ( lifestyle counseling 57 , routine prenatal care 43 ) . Baseline demographic characteristics were similar between the study groups . The lifestyle counseling group gained significantly less weight than did the routine prenatal care group ( 28.7±12.5 lb compared with 35.6±15.5 lb , P=.01 ) . The routine prenatal care group had significantly more cesarean deliveries due to “ failure to progress ” ( routine prenatal care 58.3 % compared with lifestyle counseling 25.0 % , P=.02 ) . Across groups , patients who were not adherent to the IOM guidelines had significantly heavier neonates ( adherent 3,203.2±427.2 g compared with not adherent 3,517.4±572.4 g , P<.01 ) . Nulliparous women  gained significantly more weight than did parous women ( 36.5±14.5 lb compared with 27.7±12.7 lb , P<.01 ) . The most predictive factor of IOM adherence was having a normal prepregnancy body mass index . No statistically significant differences were noted between the groups in adherence to IOM guidelines , rate of cesarean delivery , preeclampsia , GDM , operative vaginal delivery , or vaginal lacerations . CONCLUSION : An organized , consistent program of dietary and lifestyle counseling did reduce weight gain in pregnancy . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00792480 LEVEL OF EVIDENCE : Objective The influence of an exercise programme performed by healthy pregnant women on maternal glucose tolerance was studied . Study design A physical activity ( PA , l and /aquatic activities ) programme during the entire pregnancy ( three sessions per week ) was conducted by a qualified instructor . 83 healthy pregnant women were r and omly assigned to either an exercise group ( EG , n=40 ) or a control ( CG , n=43 ) group . 50 g maternal glucose screen ( MGS ) , maternal weight gain and several pregnancy outcomes were recorded . Results Significant differences were found between study groups on the 50 g MGS . Values corresponding to the EG ( 103.8±20.4 mg/dl ) were better than those of the CG ( 126.9±29.5 mg/dl ) , p=0.000 . In addition , no differences in maternal weight gain and no cases of gestational diabetes in EG versus 3 in CG ( 7 % ) ( p>0.05 ) were found . Conclusion A moderate PA programme performed during pregnancy improves levels of maternal glucose tolerance Background Excessive gestational weight gain and postpartum weight retention may predispose women to long-term overweight and other health problems . Intervention studies aim ing at preventing excessive pregnancy-related weight gain are needed . The feasibility of implementing such a study protocol in primary health care setting was evaluated in this pilot study . Methods A non-r and omized controlled trial was conducted in three intervention and three control maternity and child health clinics in primary health care in Finl and . Altogether , 132 pregnant and 92 postpartum women and 23 public health nurses ( PHN ) participated in the study . The intervention consisted of individual counselling on physical activity and diet at five routine visits to a PHN and of an option for supervised group exercise until 37 weeks ' gestation or ten months postpartum . The control clinics continued their usual care . The components of the feasibility evaluation were 1 ) recruitment and participation , 2 ) completion of data collection , 3 ) realization of the intervention and 4 ) the public health nurses ' experiences . Results 1 ) The recruitment rate was slower than expected and the recruitment period had to be prolonged from the initially planned three months to six months . The average participation rate of eligible women at study enrolment was 77 % and the drop-out rate 15 % . 2 ) In total , 99 % of the data on weight , physical activity and diet and 96 % of the blood sample s were obtained . 3 ) In the intervention clinics , 98 % of the counselling sessions were realized , their contents and average duration s were as intended , 87 % of participants regularly completed the weekly records for physical activity and diet , and the average participation percentage in the group exercise sessions was 45 % . 4 ) The PHNs regarded the extra training as a major advantage and the high additional workload as a disadvantage of the study . Conclusion The study protocol was mostly feasible to implement , which encourages conducting large trials in comparable setting s . Trial registration Current Controlled Trials IS RCT Obesity among pregnant women is becoming one of the most important women 's health issues . Obesity is associated with increased risk of almost all pregnancy complications : gestational hypertension , preeclampsia , gestational diabetes mellitus , delivery of large-for-GA infants , and higher incidence of congenital defects all occur more frequently than in women with a normal BMI . Evidence shows that a child of an obese mother may suffer from exposure to a suboptimal in utero environment and that early life adversities may extend into adulthood . In September 2009 , ILSI Europe convened a workshop with multidisciplinary expertise to review practice s and science base of health and nutrition of obese pregnant women , with focus on the long-term health of the child . The consensus viewpoint of the workshop identified gaps and gave recommendations for future research on gestational weight gain , gestational diabetes , and research method ologies . The evidence available on short- and long-term health impact for mother and child currently favors actions directed at controlling prepregnancy weight and preventing obesity in women of reproductive ages . More r and omized controlled trials are needed to evaluate the effects of nutritional and behavioral interventions in pregnancy outcomes . Moreover , suggestions that maternal obesity may transfer obesity risk to child through non-Mendelian ( e.g. epigenetic ) mechanisms require more long-term investigation Objective To examine the extent to which women planning a pregnancy comply with recommendations for nutrition and lifestyle . Design Prospect i ve cohort study . Setting Southampton , United Kingdom . Participants 12 445 non-pregnant women aged 20 - 34 recruited to the Southampton Women ’s Survey through general practice s , 238 of whom became pregnant within three months of being interviewed . Main outcome measures Folic acid supplement intake , alcohol consumption , smoking , diet , and physical activity before pregnancy . Results The 238 women who became pregnant within three months of the interview were only marginally more likely to comply with recommendations for those planning a pregnancy than those who did not become pregnant in this period . Among those who became pregnant , 2.9 % ( 95 % confidence interval 1.2 % to 6.0 % ) were taking 400 μg or more of folic acid supplements  a day and drinking four or fewer units of alcohol a week , compared with 0.66 % ( 0.52 % to 0.82 % ) of those who did not become pregnant . 74 % of those who became pregnant were non-smokers compared with 69 % of those who did not become pregnant ( P=0.08 ) . Women in both groups were equally likely to consume five or more portions of fruit and vegetables a day ( 53 % in each group , P=1.0 ) , but only 57 % of those who became pregnant had taken any strenuous exercise in the past three months compared with 64 % in those who did not become pregnant ( P=0.03 ) . Conclusion Only a small proportion of women planning a pregnancy follow the recommendations for nutrition and lifestyle . Greater publicity for the recommendations is needed , but as many pregnancies are unplanned , improved nutrition and lifestyles of women of childbearing age is also required BACKGROUND Although obesity in pregnancy continues to be associated with ongoing health problems , many clinicians have been reluctant to place nondiabetic , obese , pregnant women on a monitored , calorie-appropriate nutritional regimen for fear of fetal growth restriction , low birth weight , or starvation ketosis . METHODS A total of 257 patients were enrolled in the r and omized study , with a loss-to-follow-up rate of 9.73 % . Patients were assigned r and omly to either the control ( unmonitored ) group ( n=116 ) , consisting of conventional prenatal dietary management , or to the study ( monitored ) group ( n=116 ) , which was prescribed a balanced nutritional regimen and were asked to record in a diary all of the foods eaten during each day .  Women were eligible for the study if they were pregnant with a single fetus between 12 and 28 weeks of gestation and had a prepregnancy body mass index of more than 30 kg/m2 . The primary outcome was to compare perinatal outcomes in the control vs the study groups . The secondary measure was to compare outcomes in adherent and nonadherent patients in the study group . RESULTS Omnibus MANOVA showed statistically significant differences between the study and control groups regarding 3 variables : ( 1 ) gestational hypertension , p < .46 ; ( 2 ) mother 's last weight before delivery , p < .001 ; and ( 3 ) mother 's 6-week postpartum weight , p < .001 . Patients gaining 15 pounds or more during their pregnancy showed statistically significant differences between the groups for 8 variables . CONCLUSION Obese pregnant women may be placed on a healthy , well-balanced , monitored nutritional program during their antepartum course without adverse perinatal outcomes BACKGROUND Maternal obesity and 
    Output:
    