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 We conducted a r and omized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications . METHODS We r and omly assigned women between 24 and 34 weeks ' gestation who had gestational diabetes to receive dietary advice , blood glucose monitoring , and insulin therapy as needed ( the intervention group ) or routine care . Primary outcomes included serious perinatal complications ( defined as death , shoulder dystocia , bone fracture , and nerve palsy ) , admission to the neonatal nursery , jaundice requiring phototherapy , induction of labor , cesarean birth , and maternal anxiety , depression , and health status . RESULTS The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group ( 1 percent vs. 4 percent ; relative risk adjusted for maternal age , race or ethnic group , and parity , 0.33 ; 95 percent confidence interval , 0.14 to 0.75 ; P=0.01 ) . However , more infants of women in the intervention group were admitted to the neonatal nursery ( 71 percent vs. 61 percent ; adjusted relative risk , 1.13 ; 95 percent confidence interval , 1.03 to 1.23 ; P=0.01 ) . Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group ( 39 percent vs. 29 percent ; adjusted relative risk , 1.36 ; 95 percent confidence interval , 1.15 to 1.62 ; P<0.001 ) , although the rates of cesarean delivery were similar ( 31 percent and 32 percent , respectively ; adjusted relative risk , 0.97 ; 95 percent confidence interval , 0.81 to 1.16 ; P=0.73 ) . At three months post partum , data on the women 's mood and quality of life , available for 573 women , revealed lower rates of depression and higher scores , consistent with improved health status , in the intervention group . CONCLUSIONS Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman 's health-related quality of life Objective : To evaluate the effects of aerobic training on submaximal cardiorespiratory capacity in overweight pregnant women . Methods : We conducted a r and omized clinical trial in a referral center prenatal clinic during the period 2000–2002 . Of 132 overweight ( body mass index 26–31 kg/m2 ) but otherwise healthy volunteers , at 20 years of age or older , with gestational age of 20 weeks or less , and without diabetes or hypertension , 92 consented to participate and were r and omized . Intervention consisted of 3 one-hour aerobic exercise sessions per week ; the control group received weekly relaxation and focus group discussion s. The main outcome measure was submaximal exercise capacity evaluated by oxygen uptake at the anaerobic ( first ventilatory ) threshold during cardiopulmonary treadmill testing 12 weeks after r and omization . Results : Oxygen uptake at the anaerobic threshold increased 18 % ( 15.9 ± 2.6 to 18.1 ± 3.1 mL · min−1 · kg−1 ) in the exercise group but decreased 16 % ( 16.9 ± 3.0 to 15.8 ± 2.6 mL · min−1 · kg−1 ) among the control group . Oxygen consumption at the anaerobic threshold , adjusted through analysis of covariance for baseline oxygen uptake , was 2.68 ( 95 % confidence interval 1.23 to 4.12 ) mL · min−1 · kg−1 greater in the exercise group . Women in the exercise group were approximately 5 times more likely than those in the control group to have regular or good cardiorespiratory capacity ( 12/38 versus 2/38 ; relative risk 5.2 , 95 % confidence interval 1.2 to 22.0 , number needed to treat 5 ) . Conclusion : Aerobic training in overweight pregnant women  substantially increases submaximal exercise capacity , overcoming the otherwise negative effects of pregnancy in this regard . Additional studies are required to evaluate its effect on major clinical outcomes . LEVEL OF EVIDENCE : BACKGROUND : The Institute of Medicine ( IOM ) recommends that normal‐weight women ( BMI ( body mass index ) of 19.8–26.0 ) gain 25–35 lb ( 11.4–15.9 kg ) during pregnancy , and that overweight women ( BMI of 26.1–29.0 ) gain 15–25 lbs ( 6.8–11.4 kg ) . A significant number of normal‐weight women and an even greater proportion of overweight women exceed these guidelines , which increases postpartum weight retention and may contribute to the development of obesity . OBJECTIVE : To determine whether a stepped care , behavioral intervention will decrease the percentage of women who gain more than the IOM recommendation . DESIGN : R and omized controlled trial comparing a stepped-care behavioral intervention with usual care .  Women ( n=120 ) who had a BMI > 19.8 , age>18 and < 20 weeks gestation were recruited from a hospital-based clinic serving low-income women and r and omized by race and BMI category to the intervention or control group . The intervention group received education about weight gain , healthy eating , and exercise and individual graphs of their weight gain . Those exceeding weight gain goals were given more intensive intervention . Women were followed through pregnancy to their first postpartum clinic visit . The main outcome measure was weight gain during pregnancy categorized as above the IOM recommendations vs below or within the IOM recommendations . RESULTS : The intervention significantly decreased the percentage of normal-weight women who exceeded the IOM recommendations ( 33 vs 58 % , P<0.05 ) . There was a non-significant ( P=0.09 ) effect in the opposite direction among overweight women ( 59 % of intervention and 32 % of control gained more than recommended ) . Postpartum weight retention was strongly related to weight gain during pregnancy ( r=0.89 ) . CONCLUSIONS : The intervention reduced excessive weight gain during pregnancy among normal weight women OBJECTIVE The objective of this study was to estimate the effects of low and high gestational weight gain , in different maternal Body Mass Index ( BMI ) classes , on obstetric and neonatal outcomes . METHOD A prospect i ve population -based cohort study of 245,526 singleton term pregnancies . Women were grouped in five categories of BMI and in three gestational weight gain categories ; < 8 kg ( low weight gain ) , 8 - 16 kg and > 16 kg ( high weight gain ) . Obstetric and neonatal outcomes were evaluated after adjustments for maternal age , parity , smoking , year of birth . RESULT Obese women with low gestational weight gain had a decreased risk for the following outcomes ( adjusted odds ratio ; 95 % confidence interval ) : preeclampsia ( 0.52 ; 0.42 - 0.62 ) , cesarean section ( 0.81 ; 0.73 - 0.90 ) , instrumental delivery ( 0.75 ; 0.63 - 0.88 ) , and LGA births ( 0.66 ; 0.59 - 0.75 ) . There was a 2-fold increased risk for preeclampsia and LGA infants among average and overweight women with excessive weight gain . High gestational weight gain increased the risk for cesarean delivery in all maternal BMI classes . CONCLUSION The effects of high or low gestational weight gain differ depending on maternal BMI and the outcome variable studied . Obese women may benefit from a low weight gain during pregnancy BACKGROUND Postpregnancy weight retention contributes to the near-epidemic prevalence of obesity in the United States . This study examines the impact of an individualized , structured diet and physical activity intervention on weight loss in overweight women during the first year postpartum . METHODS Forty overweight postpartum women were r and omized to either a structured ( STR ) or a self-directed ( SELF ) intervention . Measurements included body weight , percent body fat , daily caloric intake , habitual physical activity , and cardiorespiratory fitness . Subjects in STR received individualized diet and physical activity prescriptions derived from baseline measurements . They met weekly for the first 12 weeks and kept daily food and activity diaries . Subjects in SELF received a single 1-hour educational session about diet and activity . RESULTS Only 23 of 40 participants remained in the study at 1 year postpartum . Of those , STR ( n = 13 ) had a significant weight loss ( 7.3 kg , p < 0.01 ) , a significant decrease in percent body fat ( 6 % , p < 0.01 ) , and no change in fat-free mass . SELF ( n = 10 ) had no significant change in weight , percent body fat , or fat-free mass . CONCLUSIONS Women who committed to this one class per week for 12 weeks postpartum had a high likelihood of successful weight loss that persisted at 1 year . Women who were overweight before pregnancy were unlikely to lose the pregnancy-related weight without the help of a formal intervention . This suggests that healthcare professionals should strongly encourage postpartum women to enroll in a structured diet and exercise program Summary : A r and omised controlled trial was design ed to determine the effect of moderate 30 % maternal dietary energy restriction on the requirement for maternal insulin therapy  and the incidence of macrosomia in gestational diabetes .  Although the control group restricted their intake to a level similar to that of the intervention group ( 6845 kiloJoules ( kJ ) versus 6579 kJ ) , the result ing cohort could not identify any adverse effect of energy restriction in pregnancy . Energy restriction did not alter the frequency of insulin therapy ( 17.5 % in the intervention group and 16.9 % in the control group ) . Mean birth weight  ( 3461 g in the intervention group and 3267 g in the control group ) was not affected . There was a trend in the intervention group towards later gestational age at commencement of insulin therapy ( 33 weeks versus 31 weeks ) and lower maximum daily insulin dose ( 23 units versus 60 units ) which did not reach statistical significance . Energy restriction did not cause an increase in ketonemia Exercise prescriptions that can be translated into clinical recommendations are clearly needed for women with gestational diabetes mellitus ( GDM ) . A pilot project was developed to document the effectiveness of a structured low-intensity walking protocol on capillary glucose control in GDM women . Ten GDM women followed conventional management of diet and insulin therapy , plus a low-intensity walking program ( W ) from diagnosis to delivery . Capillary glucose concentrations , insulin requirements , and pregnancy outcomes were compared with a matched cohort by body mass index ( BMI ) , age , and insulin usage ( 20 GDM women who followed conventional management alone ( C ) ) . Baseline capillary glucose concentrations were not significantly different between the W and C groups . The W group had an average acute drop in capillary glucose concentration from pre- to post-exercise of 2.0 mmol x L(-1 ) . In addition , the W group had significantly lower mean glucose concentrations in the fasted state and 1 h after meals than the C group in the week prior to delivery . These lower glucose concentrations were achieved while requiring fewer units of insulin per day ( C , 0.50 + /- 0.37 U x kg(-1 ) ; W , 0.16 + /- 0.13 U x kg(-1 ) ; p < 0.05 ) , injected less frequently . These results suggest an effective role in glucose regulation for this structured walking program BACKGROUND A high prevalence of gestational diabetes mellitus and type 2 diabetes has been observed among the Cree of James Bay , Quebec . To address this problem , a diet and activity intervention during pregnancy , which was based on social learning theory , was initiated in 4 Cree communities . METHODS A prospect i ve intervention compared dietary , weight and glycemic indicators for 107 control subjects and for 112 women who received the intervention during the course of their pregnancy . A control period in 4 communities ( July 1995-March 1996 ) was followed by an intervention period ( April 1996-January 1997 ) when subjects were offered regular , individual diet counselling , physical activity sessions and other activities related to nutrition . RESULTS The intervention and control groups did not differ at baseline regarding their mean age ( 24.3 years [ SD 6.29 ] v. 23.8 years [ SD 5.86 ] ) , mean prepregnancy weight ( 81.0 kg [ SD 19.46 ] v. 78.9 kg [ SD 17.54 ] ) and mean gestational age at recruitment ( 17.1 weeks [ SD 7.06 ] v. 18.5 weeks [ SD 6.92 ] ) . The intervention did not result in differences in diet measured at 24 - 30 weeks ' gestation , rate of weight gain over the second half of pregnancy ( 0.53 kg per week [ SD 0.32 ] v. 0.53 kg per week [ SD 0.27 ] ) or plasma glucose level ( 50 g oral glucose screen ) between 24 and 30 weeks ( 7.21 mmol/L [ SD 2.09 ] v. 7.43 mmol/L [ 
    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 We conducted a r and omized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications . METHODS We r and omly assigned women between 24 and 34 weeks ' gestation who had gestational diabetes to receive dietary advice , blood glucose monitoring , and insulin therapy as needed ( the intervention group ) or routine care . Primary outcomes included serious perinatal complications ( defined as death , shoulder dystocia , bone fracture , and nerve palsy ) , admission to the neonatal nursery , jaundice requiring phototherapy , induction of labor , cesarean birth , and maternal anxiety , depression , and health status . RESULTS The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group ( 1 percent vs. 4 percent ; relative risk adjusted for maternal age , race or ethnic group , and parity , 0.33 ; 95 percent confidence interval , 0.14 to 0.75 ; P=0.01 ) . However , more infants of women in the intervention group were admitted to the neonatal nursery ( 71 percent vs. 61 percent ; adjusted relative risk , 1.13 ; 95 percent confidence interval , 1.03 to 1.23 ; P=0.01 ) . Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group ( 39 percent vs. 29 percent ; adjusted relative risk , 1.36 ; 95 percent confidence interval , 1.15 to 1.62 ; P<0.001 ) , although the rates of cesarean delivery were similar ( 31 percent and 32 percent , respectively ; adjusted relative risk , 0.97 ; 95 percent confidence interval , 0.81 to 1.16 ; P=0.73 ) . At three months post partum , data on the women 's mood and quality of life , available for 573 women , revealed lower rates of depression and higher scores , consistent with improved health status , in the intervention group . CONCLUSIONS Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman 's health-related quality of life Objective : To evaluate the effects of aerobic training on submaximal cardiorespiratory capacity in overweight pregnant women . Methods : We conducted a r and omized clinical trial in a referral center prenatal clinic during the period 2000–2002 . Of 132 overweight ( body mass index 26–31 kg/m2 ) but otherwise healthy volunteers , at 20 years of age or older , with gestational age of 20 weeks or less , and without diabetes or hypertension , 92 consented to participate and were r and omized . Intervention consisted of 3 one-hour aerobic exercise sessions per week ; the control group received weekly relaxation and focus group discussion s. The main outcome measure was submaximal exercise capacity evaluated by oxygen uptake at the anaerobic ( first ventilatory ) threshold during cardiopulmonary treadmill testing 12 weeks after r and omization . Results : Oxygen uptake at the anaerobic threshold increased 18 % ( 15.9 ± 2.6 to 18.1 ± 3.1 mL · min−1 · kg−1 ) in the exercise group but decreased 16 % ( 16.9 ± 3.0 to 15.8 ± 2.6 mL · min−1 · kg−1 ) among the control group . Oxygen consumption at the anaerobic threshold , adjusted through analysis of covariance for baseline oxygen uptake , was 2.68 ( 95 % confidence interval 1.23 to 4.12 ) mL · min−1 · kg−1 greater in the exercise group . Women in the exercise group were approximately 5 times more likely than those in the control group to have regular or good cardiorespiratory capacity ( 12/38 versus 2/38 ; relative risk 5.2 , 95 % confidence interval 1.2 to 22.0 , number needed to treat 5 ) . Conclusion : Aerobic training in overweight pregnant women  substantially increases submaximal exercise capacity , overcoming the otherwise negative effects of pregnancy in this regard . Additional studies are required to evaluate its effect on major clinical outcomes . LEVEL OF EVIDENCE : BACKGROUND : The Institute of Medicine ( IOM ) recommends that normal‐weight women ( BMI ( body mass index ) of 19.8–26.0 ) gain 25–35 lb ( 11.4–15.9 kg ) during pregnancy , and that overweight women ( BMI of 26.1–29.0 ) gain 15–25 lbs ( 6.8–11.4 kg ) . A significant number of normal‐weight women and an even greater proportion of overweight women exceed these guidelines , which increases postpartum weight retention and may contribute to the development of obesity . OBJECTIVE : To determine whether a stepped care , behavioral intervention will decrease the percentage of women who gain more than the IOM recommendation . DESIGN : R and omized controlled trial comparing a stepped-care behavioral intervention with usual care .  Women ( n=120 ) who had a BMI > 19.8 , age>18 and < 20 weeks gestation were recruited from a hospital-based clinic serving low-income women and r and omized by race and BMI category to the intervention or control group . The intervention group received education about weight gain , healthy eating , and exercise and individual graphs of their weight gain . Those exceeding weight gain goals were given more intensive intervention . Women were followed through pregnancy to their first postpartum clinic visit . The main outcome measure was weight gain during pregnancy categorized as above the IOM recommendations vs below or within the IOM recommendations . RESULTS : The intervention significantly decreased the percentage of normal-weight women who exceeded the IOM recommendations ( 33 vs 58 % , P<0.05 ) . There was a non-significant ( P=0.09 ) effect in the opposite direction among overweight women ( 59 % of intervention and 32 % of control gained more than recommended ) . Postpartum weight retention was strongly related to weight gain during pregnancy ( r=0.89 ) . CONCLUSIONS : The intervention reduced excessive weight gain during pregnancy among normal weight women OBJECTIVE The objective of this study was to estimate the effects of low and high gestational weight gain , in different maternal Body Mass Index ( BMI ) classes , on obstetric and neonatal outcomes . METHOD A prospect i ve population -based cohort study of 245,526 singleton term pregnancies . Women were grouped in five categories of BMI and in three gestational weight gain categories ; < 8 kg ( low weight gain ) , 8 - 16 kg and > 16 kg ( high weight gain ) . Obstetric and neonatal outcomes were evaluated after adjustments for maternal age , parity , smoking , year of birth . RESULT Obese women with low gestational weight gain had a decreased risk for the following outcomes ( adjusted odds ratio ; 95 % confidence interval ) : preeclampsia ( 0.52 ; 0.42 - 0.62 ) , cesarean section ( 0.81 ; 0.73 - 0.90 ) , instrumental delivery ( 0.75 ; 0.63 - 0.88 ) , and LGA births ( 0.66 ; 0.59 - 0.75 ) . There was a 2-fold increased risk for preeclampsia and LGA infants among average and overweight women with excessive weight gain . High gestational weight gain increased the risk for cesarean delivery in all maternal BMI classes . CONCLUSION The effects of high or low gestational weight gain differ depending on maternal BMI and the outcome variable studied . Obese women may benefit from a low weight gain during pregnancy BACKGROUND Postpregnancy weight retention contributes to the near-epidemic prevalence of obesity in the United States . This study examines the impact of an individualized , structured diet and physical activity intervention on weight loss in overweight women during the first year postpartum . METHODS Forty overweight postpartum women were r and omized to either a structured ( STR ) or a self-directed ( SELF ) intervention . Measurements included body weight , percent body fat , daily caloric intake , habitual physical activity , and cardiorespiratory fitness . Subjects in STR received individualized diet and physical activity prescriptions derived from baseline measurements . They met weekly for the first 12 weeks and kept daily food and activity diaries . Subjects in SELF received a single 1-hour educational session about diet and activity . RESULTS Only 23 of 40 participants remained in the study at 1 year postpartum . Of those , STR ( n = 13 ) had a significant weight loss ( 7.3 kg , p < 0.01 ) , a significant decrease in percent body fat ( 6 % , p < 0.01 ) , and no change in fat-free mass . SELF ( n = 10 ) had no significant change in weight , percent body fat , or fat-free mass . CONCLUSIONS Women who committed to this one class per week for 12 weeks postpartum had a high likelihood of successful weight loss that persisted at 1 year . Women who were overweight before pregnancy were unlikely to lose the pregnancy-related weight without the help of a formal intervention . This suggests that healthcare professionals should strongly encourage postpartum women to enroll in a structured diet and exercise program Summary : A r and omised controlled trial was design ed to determine the effect of moderate 30 % maternal dietary energy restriction on the requirement for maternal insulin therapy  and the incidence of macrosomia in gestational diabetes .  Although the control group restricted their intake to a level similar to that of the intervention group ( 6845 kiloJoules ( kJ ) versus 6579 kJ ) , the result ing cohort could not identify any adverse effect of energy restriction in pregnancy . Energy restriction did not alter the frequency of insulin therapy ( 17.5 % in the intervention group and 16.9 % in the control group ) . Mean birth weight  ( 3461 g in the intervention group and 3267 g in the control group ) was not affected . There was a trend in the intervention group towards later gestational age at commencement of insulin therapy ( 33 weeks versus 31 weeks ) and lower maximum daily insulin dose ( 23 units versus 60 units ) which did not reach statistical significance . Energy restriction did not cause an increase in ketonemia Exercise prescriptions that can be translated into clinical recommendations are clearly needed for women with gestational diabetes mellitus ( GDM ) . A pilot project was developed to document the effectiveness of a structured low-intensity walking protocol on capillary glucose control in GDM women . Ten GDM women followed conventional management of diet and insulin therapy , plus a low-intensity walking program ( W ) from diagnosis to delivery . Capillary glucose concentrations , insulin requirements , and pregnancy outcomes were compared with a matched cohort by body mass index ( BMI ) , age , and insulin usage ( 20 GDM women who followed conventional management alone ( C ) ) . Baseline capillary glucose concentrations were not significantly different between the W and C groups . The W group had an average acute drop in capillary glucose concentration from pre- to post-exercise of 2.0 mmol x L(-1 ) . In addition , the W group had significantly lower mean glucose concentrations in the fasted state and 1 h after meals than the C group in the week prior to delivery . These lower glucose concentrations were achieved while requiring fewer units of insulin per day ( C , 0.50 + /- 0.37 U x kg(-1 ) ; W , 0.16 + /- 0.13 U x kg(-1 ) ; p < 0.05 ) , injected less frequently . These results suggest an effective role in glucose regulation for this structured walking program BACKGROUND A high prevalence of gestational diabetes mellitus and type 2 diabetes has been observed among the Cree of James Bay , Quebec . To address this problem , a diet and activity intervention during pregnancy , which was based on social learning theory , was initiated in 4 Cree communities . METHODS A prospect i ve intervention compared dietary , weight and glycemic indicators for 107 control subjects and for 112 women who received the intervention during the course of their pregnancy . A control period in 4 communities ( July 1995-March 1996 ) was followed by an intervention period ( April 1996-January 1997 ) when subjects were offered regular , individual diet counselling , physical activity sessions and other activities related to nutrition . RESULTS The intervention and control groups did not differ at baseline regarding their mean age ( 24.3 years [ SD 6.29 ] v. 23.8 years [ SD 5.86 ] ) , mean prepregnancy weight ( 81.0 kg [ SD 19.46 ] v. 78.9 kg [ SD 17.54 ] ) and mean gestational age at recruitment ( 17.1 weeks [ SD 7.06 ] v. 18.5 weeks [ SD 6.92 ] ) . The intervention did not result in differences in diet measured at 24 - 30 weeks ' gestation , rate of weight gain over the second half of pregnancy ( 0.53 kg per week [ SD 0.32 ] v. 0.53 kg per week [ SD 0.27 ] ) or plasma glucose level ( 50 g oral glucose screen ) between 24 and 30 weeks ( 7.21 mmol/L [ SD 2.09 ] v. 7.43 mmol/L [ 
    Output:
    