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 This analysis was focused on 1-year maternal and infant follow-up of a r and omized trial that tested a weight management intervention conducted during pregnancy . METHODS One hundred fourteen women with obesity ( mean BMI 36.7 kg/m(2 ) ) were r and omly assigned at a mean of 15 weeks gestation to a weight management intervention or usual care control condition . The intervention ended at delivery and result ed in less gestational weight gain and a lower proportion of large-for-gestational-age newborns among intervention compared with control participants . The primary outcome at 12 months postpartum was maternal weight . Secondary outcomes included infant weight-for-age and weight-for-length z-scores . RESULTS At 1 year , mothers in the intervention group weighed 96.3 ± 18.6 kg and those in the control group 99.7 ± 19.2 kg . There was no significant difference between groups in change in weight from r and omization to 1 year postpartum ( b = -0.47 , 95 % CI : -4.03 to 3.08 ) . There was a significant main effect of group for infant weight-for-age z-scores ( b = -0.40 , 95 % CI : -0.75 to -0.05 ) but not infant weight-for-length z-scores ( b = -0.20 , 95 % CI : -0.59 to 0.20 ) . CONCLUSIONS A gestational weight management intervention did not influence maternal weight or infant weight-for-length at 1 year postpartum . Future studies may be warranted to determine whether extending prenatal interventions into the postpartum period would be beneficial for maternal and infant outcomes 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 2.8 years of age . This may reflect the limited difference in GWG between intervention and control groups . Offspring of obese mothers from the RCT were comparable to offspring of mothers with a normal BMI . Trial registration clinical trials.gov NCT00530439 , NCT01918319 and NCT01918423 . URL : NCT00530439?term = NCT00530439&rank = 1 , NCT01918319?term = NCT00530439&rank = 2 and NCT01918423?term = NCT00530439&rank = 3 Objective To determine if a low glycaemic index diet in pregnancy could reduce the incidence of macrosomia in an at risk group . Design R and omised controlled trial . Setting Maternity hospital in Dublin , Irel and . Participants 800 women without diabetes , all in their second pregnancy between January 2007 to January 2011 , having previously delivered an infant weighing greater than 4 kg . Intervention Women were r and omised to receive no dietary intervention or start on a low glycaemic index diet from early pregnancy . Main outcomes The primary outcome measure was difference in birth weight . The secondary outcome measure was difference in gestational weight gain . Results No significant difference was seen between the two groups in absolute birth weight , birthweight centile , or ponderal index . Significantly less gestational weight gain occurred in women in the intervention arm ( 12.2 v 13.7 kg ; mean difference −1.3 , 95 % confidence interval −2.4 to −0.2 ; P=0.01 ) . The rate of glucose intolerance was also lower in the intervention arm : 21 % ( 67/320 ) compared with 28 % ( 100/352 ) of controls had a fasting glucose of 5.1 mmol/L or greater or a 1 hour glucose challenge test result of greater than 7.8 mmol/L ( P=0.02 ) . Conclusion A low glycaemic index diet in pregnancy did not reduce the incidence of large for gestational age  infants in a group at risk of fetal macrosomia . It did , however , have a significant positive effect on gestational weight gain and maternal glucose intolerance . Trial registration Current Controlled Trials IS RCT N54392969 INTRODUCTION Excessive and inadequate gestational weight gain can complicate a woman 's pregnancy and put her and her child at risk for poor delivery and birth outcomes . Further , feeding and activity habits established early in life can significantly impact the development of childhood obesity . METHODS The on-going Delta Healthy Sprouts Project is a r and omized , controlled , comparative trial testing the efficacy of two Maternal , Infant , and Early Childhood Home Visiting programs on weight status and health behaviors of 150 mothers and their infants residing in the rural Mississippi Delta region of the United States . Women are enrolled in their second trimester of pregnancy and r and omized to one of two treatment arms . The control arm curriculum is based on Parents as Teachers , an evidence based approach to increase parental knowledge of child development and improve parenting practice s. The experimental arm , labeled Parents as Teachers Enhanced , builds upon the control curriculum by including culturally tailored nutrition and physical activity components specifically design ed for the gestational and postnatal periods . We hypothesize that , as compared to the control arm , the experimental arm will be more effective in preventing inappropriate gestational weight gain , reducing postnatal weight retention , and decreasing infant obesity rates . We also will evaluate mother and child dietary and physical activity outcomes , breastfeeding initiation and continuation , and child feeding practice s. CONCLUSION The Delta Healthy Sprouts Project tests a novel , combined approach to maternal weight management and childhood obesity prevention in pregnant women and their children at high risk for obesity and chronic disease Background Excessive gestational weight gain ( GWG ) is associated with short- and long-term health problems among mothers and their offspring . There is a strong need for effective intervention strategies targeting excessive GWG to prevent adverse outcomes . Methods We performed a cluster-r and omized controlled intervention trial in eight gynecological practice s evaluating the feasibility and effectiveness of a lifestyle intervention presented to all pregnant women ; 250 healthy , pregnant women were recruited for the study . The intervention program consisted of two individually delivered counseling sessions focusing on diet , physical activity , and weight monitoring . The primary outcome was the proportion of pregnant women exceeding weight gain recommendations of the Institute of Medicine ( IOM ) . Secondary outcome variables were maternal weight retention and short-term obstetric and neonatal outcomes . Results The intervention result ed in a lower proportion of women exceeding IOM guidelines among women in the intervention group ( 38 % ) compared with the control group ( 60 % ) ( odds ratio ( OR ) : 0.5 ; 95 % confidence interval ( CI ) : 0.3 to 0.9 ) without prompting an increase in the proportion of pregnancies with suboptimal weight gain ( 19 % vs. 21 % ) . Participants in the intervention group gained significantly less weight than those in the control group . Only 17 % of the women in the intervention group showed substantial weight retention of more than 5 kg compared with 31 % of those in the control group at month four postpartum ( pp ) ( OR : 0.5 ; 95 % CI : 0.2 to 0.9 ) . There were no significant differences in obstetric and neonatal outcomes . Conclusions Lifestyle counseling given to pregnant women reduced the proportion of pregnancies with excessive GWG without increasing suboptimal weight gain , and may exert favorable effects on pp weight retention . Trial registration German Clinical Trials Register DRKS00003801 BACKGROUND Behavioural interventions might improve clinical outcomes in pregnant women who are obese . We aim ed to investigate whether a complex intervention addressing diet and physical activity could reduce the incidence of gestational diabetes and large-for-gestational-age infants . METHODS The UK Pregnancies Better Eating and Activity Trial ( UPBEAT ) is a r and omised controlled trial done at antenatal clinics in eight hospitals in multi-ethnic , inner-city locations in the UK . We recruited pregnant women ( 15 - 18 weeks plus 6 days of gestation ) older than 16 years who were obese ( BMI ≥30 kg/m(2 ) ) . We r and omly assigned participants to either a behavioural intervention or st and ard antenatal care with an internet-based , computer-generated , r and omisation procedure , minimising by age , ethnic origin , centre , BMI , and parity . The intervention was delivered once a week through eight health trainer-led sessions . Primary outcomes were gestational diabetes ( diagnosed with an oral glucose tolerance test and by criteria from the International Association of Diabetes in Pregnancy Study Groups ) and large-for-gestational-age infants ( ≥90th customised birthweight centile ) . Analysis was by intention to treat . This trial is registered with Current Controlled Trials , ISCRTN89971375 . Recruitment and pregnancy outcomes are complete but childhood follow-up is ongoing . FINDINGS Between March 31 , 2009 , and June 2 , 2014 , we assessed 8820 women for eligibility and recruited 1555 , with a mean BMI of 36·3 kg/m(2 ) ( SD 4·8 ) . 772 were r and omly assigned to st and ard antenatal care and 783 were allocated the behavioural intervention , of which 651 and 629 women , respectively , completed an oral glucose tolerance test . Gestational diabetes was reported in 172 ( 26 % ) women in the st and ard care group compared with 160 ( 25 % ) in the intervention group ( risk ratio 0·96 , 95 % CI 0·79 - 1·16 ; p=0·68 ) . 61 ( 8 % ) of 751 babies in the st and ard care group were large for gestational age compared with 71 ( 9 % ) of 761 in the intervention group ( 1·15 , 0·83 - 1·59 ; p=0·40 ) . Thus , the primary outcomes did not differ between groups , despite improvements in some maternal secondary outcomes in the intervention group , including reduced dietary glycaemic load , gestational weight gain , and maternal sum-of-skinfold thicknesses , and increased physical activity . Adverse events included neonatal death ( two in the st and ard care group and three in the intervention group ) and fetal death in utero ( ten in the st and ard care group and six in the intervention group ) . No maternal deaths were reported . Incidence of miscarriage ( 2 % in the st and ard care group vs 2 % in the intervention group ) , major obstetric haemorrhage ( 1 % vs 3 % ) , and small-for-gestational-age infants ( ≤5th customised birthweight centile ; 6 % vs 5 % ) did not differ between groups . INTERPRETATION A behavioural intervention addressing diet and physical activity in women with obesity during pregnancy is not adequate to prevent gestational diabetes , or to reduce the incidence of large-for-gestational-age infants . FUNDING National Institute for Health Research , Guys and St Thomas ' Charity , Chief Scientist Office Scotl and , Tommy 's Charity to test early  nutritional interventions  and prospect i ve observational cohorts . RCTs are generally accepted as method ologically the best approach for informing health policy . They can equalise unknown as well as known confounding factors and so can demonstrate causation ; they permit estimation of effect size and so can be used to assess likely Background Excessive gestational weight gain ( GWG ) is associated with elevated weight retention in mothers and might be related to adiposity of their offspring . Little is known if lifestyle intervention during pregnancy has beneficial effects for mothers and children beyond gestation . Methods A cluster-r and omized controlled intervention trial was performed with 
    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 This analysis was focused on 1-year maternal and infant follow-up of a r and omized trial that tested a weight management intervention conducted during pregnancy . METHODS One hundred fourteen women with obesity ( mean BMI 36.7 kg/m(2 ) ) were r and omly assigned at a mean of 15 weeks gestation to a weight management intervention or usual care control condition . The intervention ended at delivery and result ed in less gestational weight gain and a lower proportion of large-for-gestational-age newborns among intervention compared with control participants . The primary outcome at 12 months postpartum was maternal weight . Secondary outcomes included infant weight-for-age and weight-for-length z-scores . RESULTS At 1 year , mothers in the intervention group weighed 96.3 ± 18.6 kg and those in the control group 99.7 ± 19.2 kg . There was no significant difference between groups in change in weight from r and omization to 1 year postpartum ( b = -0.47 , 95 % CI : -4.03 to 3.08 ) . There was a significant main effect of group for infant weight-for-age z-scores ( b = -0.40 , 95 % CI : -0.75 to -0.05 ) but not infant weight-for-length z-scores ( b = -0.20 , 95 % CI : -0.59 to 0.20 ) . CONCLUSIONS A gestational weight management intervention did not influence maternal weight or infant weight-for-length at 1 year postpartum . Future studies may be warranted to determine whether extending prenatal interventions into the postpartum period would be beneficial for maternal and infant outcomes 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 2.8 years of age . This may reflect the limited difference in GWG between intervention and control groups . Offspring of obese mothers from the RCT were comparable to offspring of mothers with a normal BMI . Trial registration clinical trials.gov NCT00530439 , NCT01918319 and NCT01918423 . URL : NCT00530439?term = NCT00530439&rank = 1 , NCT01918319?term = NCT00530439&rank = 2 and NCT01918423?term = NCT00530439&rank = 3 Objective To determine if a low glycaemic index diet in pregnancy could reduce the incidence of macrosomia in an at risk group . Design R and omised controlled trial . Setting Maternity hospital in Dublin , Irel and . Participants 800 women without diabetes , all in their second pregnancy between January 2007 to January 2011 , having previously delivered an infant weighing greater than 4 kg . Intervention Women were r and omised to receive no dietary intervention or start on a low glycaemic index diet from early pregnancy . Main outcomes The primary outcome measure was difference in birth weight . The secondary outcome measure was difference in gestational weight gain . Results No significant difference was seen between the two groups in absolute birth weight , birthweight centile , or ponderal index . Significantly less gestational weight gain occurred in women in the intervention arm ( 12.2 v 13.7 kg ; mean difference −1.3 , 95 % confidence interval −2.4 to −0.2 ; P=0.01 ) . The rate of glucose intolerance was also lower in the intervention arm : 21 % ( 67/320 ) compared with 28 % ( 100/352 ) of controls had a fasting glucose of 5.1 mmol/L or greater or a 1 hour glucose challenge test result of greater than 7.8 mmol/L ( P=0.02 ) . Conclusion A low glycaemic index diet in pregnancy did not reduce the incidence of large for gestational age  infants in a group at risk of fetal macrosomia . It did , however , have a significant positive effect on gestational weight gain and maternal glucose intolerance . Trial registration Current Controlled Trials IS RCT N54392969 INTRODUCTION Excessive and inadequate gestational weight gain can complicate a woman 's pregnancy and put her and her child at risk for poor delivery and birth outcomes . Further , feeding and activity habits established early in life can significantly impact the development of childhood obesity . METHODS The on-going Delta Healthy Sprouts Project is a r and omized , controlled , comparative trial testing the efficacy of two Maternal , Infant , and Early Childhood Home Visiting programs on weight status and health behaviors of 150 mothers and their infants residing in the rural Mississippi Delta region of the United States . Women are enrolled in their second trimester of pregnancy and r and omized to one of two treatment arms . The control arm curriculum is based on Parents as Teachers , an evidence based approach to increase parental knowledge of child development and improve parenting practice s. The experimental arm , labeled Parents as Teachers Enhanced , builds upon the control curriculum by including culturally tailored nutrition and physical activity components specifically design ed for the gestational and postnatal periods . We hypothesize that , as compared to the control arm , the experimental arm will be more effective in preventing inappropriate gestational weight gain , reducing postnatal weight retention , and decreasing infant obesity rates . We also will evaluate mother and child dietary and physical activity outcomes , breastfeeding initiation and continuation , and child feeding practice s. CONCLUSION The Delta Healthy Sprouts Project tests a novel , combined approach to maternal weight management and childhood obesity prevention in pregnant women and their children at high risk for obesity and chronic disease Background Excessive gestational weight gain ( GWG ) is associated with short- and long-term health problems among mothers and their offspring . There is a strong need for effective intervention strategies targeting excessive GWG to prevent adverse outcomes . Methods We performed a cluster-r and omized controlled intervention trial in eight gynecological practice s evaluating the feasibility and effectiveness of a lifestyle intervention presented to all pregnant women ; 250 healthy , pregnant women were recruited for the study . The intervention program consisted of two individually delivered counseling sessions focusing on diet , physical activity , and weight monitoring . The primary outcome was the proportion of pregnant women exceeding weight gain recommendations of the Institute of Medicine ( IOM ) . Secondary outcome variables were maternal weight retention and short-term obstetric and neonatal outcomes . Results The intervention result ed in a lower proportion of women exceeding IOM guidelines among women in the intervention group ( 38 % ) compared with the control group ( 60 % ) ( odds ratio ( OR ) : 0.5 ; 95 % confidence interval ( CI ) : 0.3 to 0.9 ) without prompting an increase in the proportion of pregnancies with suboptimal weight gain ( 19 % vs. 21 % ) . Participants in the intervention group gained significantly less weight than those in the control group . Only 17 % of the women in the intervention group showed substantial weight retention of more than 5 kg compared with 31 % of those in the control group at month four postpartum ( pp ) ( OR : 0.5 ; 95 % CI : 0.2 to 0.9 ) . There were no significant differences in obstetric and neonatal outcomes . Conclusions Lifestyle counseling given to pregnant women reduced the proportion of pregnancies with excessive GWG without increasing suboptimal weight gain , and may exert favorable effects on pp weight retention . Trial registration German Clinical Trials Register DRKS00003801 BACKGROUND Behavioural interventions might improve clinical outcomes in pregnant women who are obese . We aim ed to investigate whether a complex intervention addressing diet and physical activity could reduce the incidence of gestational diabetes and large-for-gestational-age infants . METHODS The UK Pregnancies Better Eating and Activity Trial ( UPBEAT ) is a r and omised controlled trial done at antenatal clinics in eight hospitals in multi-ethnic , inner-city locations in the UK . We recruited pregnant women ( 15 - 18 weeks plus 6 days of gestation ) older than 16 years who were obese ( BMI ≥30 kg/m(2 ) ) . We r and omly assigned participants to either a behavioural intervention or st and ard antenatal care with an internet-based , computer-generated , r and omisation procedure , minimising by age , ethnic origin , centre , BMI , and parity . The intervention was delivered once a week through eight health trainer-led sessions . Primary outcomes were gestational diabetes ( diagnosed with an oral glucose tolerance test and by criteria from the International Association of Diabetes in Pregnancy Study Groups ) and large-for-gestational-age infants ( ≥90th customised birthweight centile ) . Analysis was by intention to treat . This trial is registered with Current Controlled Trials , ISCRTN89971375 . Recruitment and pregnancy outcomes are complete but childhood follow-up is ongoing . FINDINGS Between March 31 , 2009 , and June 2 , 2014 , we assessed 8820 women for eligibility and recruited 1555 , with a mean BMI of 36·3 kg/m(2 ) ( SD 4·8 ) . 772 were r and omly assigned to st and ard antenatal care and 783 were allocated the behavioural intervention , of which 651 and 629 women , respectively , completed an oral glucose tolerance test . Gestational diabetes was reported in 172 ( 26 % ) women in the st and ard care group compared with 160 ( 25 % ) in the intervention group ( risk ratio 0·96 , 95 % CI 0·79 - 1·16 ; p=0·68 ) . 61 ( 8 % ) of 751 babies in the st and ard care group were large for gestational age compared with 71 ( 9 % ) of 761 in the intervention group ( 1·15 , 0·83 - 1·59 ; p=0·40 ) . Thus , the primary outcomes did not differ between groups , despite improvements in some maternal secondary outcomes in the intervention group , including reduced dietary glycaemic load , gestational weight gain , and maternal sum-of-skinfold thicknesses , and increased physical activity . Adverse events included neonatal death ( two in the st and ard care group and three in the intervention group ) and fetal death in utero ( ten in the st and ard care group and six in the intervention group ) . No maternal deaths were reported . Incidence of miscarriage ( 2 % in the st and ard care group vs 2 % in the intervention group ) , major obstetric haemorrhage ( 1 % vs 3 % ) , and small-for-gestational-age infants ( ≤5th customised birthweight centile ; 6 % vs 5 % ) did not differ between groups . INTERPRETATION A behavioural intervention addressing diet and physical activity in women with obesity during pregnancy is not adequate to prevent gestational diabetes , or to reduce the incidence of large-for-gestational-age infants . FUNDING National Institute for Health Research , Guys and St Thomas ' Charity , Chief Scientist Office Scotl and , Tommy 's Charity to test early  nutritional interventions  and prospect i ve observational cohorts . RCTs are generally accepted as method ologically the best approach for informing health policy . They can equalise unknown as well as known confounding factors and so can demonstrate causation ; they permit estimation of effect size and so can be used to assess likely Background Excessive gestational weight gain ( GWG ) is associated with elevated weight retention in mothers and might be related to adiposity of their offspring . Little is known if lifestyle intervention during pregnancy has beneficial effects for mothers and children beyond gestation . Methods A cluster-r and omized controlled intervention trial was performed with 
    Output:
    