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: In this study , we assessed maternal-fetal outcomes in untreated patients with increasing carbohydrate intolerance not meeting the current criteria for the diagnosis of gestational diabetes mellitus ( GDM ) , examined the relationship between birth weight and mode of delivery among women with untreated borderline GDM , treated overt GDM , and normoglycemia , and established more efficient screening strategies for detection of GDM . This was a prospect i ve analytic cohort study in which nondiabetic women aged > or = 24 years were eligible for enrollment . A 50-g glucose challenge test ( GCT ) and a 100-g oral glucose tolerance test ( OGTT ) were administered at 26 and 28 weeks gestational age , respectively . Risk factors for unfavorable maternal-fetal outcomes were recorded . Time since the last meal  prior to the screening test was recorded , as well . Caregivers and patients were blinded to glucose values except when test results met the National Diabetes Data Group criteria for GDM . Maternal and fetal outcomes , including the mode of the delivery , were recorded in the postpartum period . Of 4,274 patients screened , 3,836 ( 90 % ) continued to the diagnostic oral glucose tolerance test . GDM was seen in 145 women . Increasing carbohydrate intolerance in women without overt gestational diabetes was associated with a significantly increased incidence of cesarean section , preeclampsia , macrosomia , and need for phototherapy , as well as an increased length of maternal and neonatal hospital stay . Multivariate analysis showed that increasing carbohydrate intolerance remained an independent predictor for various unfavorable outcomes , but the strength of the associations was diminished . Compared with normoglycemic control subjects , the untreated borderline GDM group had increased rates of macrosomia ( 28.7 vs. 13.7 % , P < 0.001 ) and cesarean delivery ( 29.6 vs. 20.2 % , P = 0.03 ) . Usual care of known GDM patients normalized birth weights , but the cesarean delivery rate was about 33 % , whether macrosomia was present or absent . An increased risk of cesarean delivery among treated patients compared with normoglycemic control subjects persisted after adjustment for multiple maternal risk factors . As for the screening tests , time since the last meal had a marked effect on mean plasma glucose . Receiver operating characteristic curve analysis allowed the selection of the most efficient cut points for the GCT based on the time since the last meal . These cut points were 8.2 , 7.9 , and 8.3 mmol/l ( 1 mmol/l = 18.015 mg/dl ) for elapsed postpr and ial time of < 2 , 2 - 3 , and > 3 h , respectively . With this change from the current threshold of 7.8 mmol/l , the number of patients with a positive screening test dropped from 18.5 to 13.7 % . There was an increase in positive predictive value from 14.4 to 18.7 % . The overall rate of patient misclassification fell from 18.0 to 13.1 % . In conclusion , increasing maternal carbohydrate intolerance in pregnant women without GDM is associated with a grade d increase in adverse maternal and fetal outcomes . Infant macrosomia is an important factor in high cesarean delivery rates for women with untreated borderline GDM . Although detection and treatment of GDM normalizes birth weights , rates of cesarean delivery remain inexplicably high . Recognition of GDM may lead to a lower threshold for surgical delivery . The efficiency of screening for GDM can be enhanced by adjusting the current GCT threshold of 7.8 mmol/l to new values related to time since the last meal before screening . Further analyses are underway to eluci date whether maternal risk factors can be used to achieve additional efficiency gains in screening OBJECTIVE Studies in predominantly non-Hispanic white population s have suggested that physical activity during pregnancy is associated with a reduced risk of gestational diabetes mellitus ( GDM ) . There are few such studies in Hispanic women , a group at increased risk for GDM . METHODS We conducted a prospect i ve cohort study of household/caregiving , occupational , sports/exercise , and active living habits and the risk of GDM among 1006 Hispanic ( predominantly Puerto Rican ) prenatal care patients in western Massachusetts from 2000 to 2004 . Prepregnancy , early pregnancy , and midpregnancy physical activity was assessed using the Kaiser Physical Activity Survey . RESULTS A total of 33 women ( 3.3 % ) were diagnosed with GDM , and 119 women ( 11.8 % ) were diagnosed with abnormal glucose tolerance . There were no significant associations between GDM risk and occupational and active living activities  in prepregnancy , early pregnancy , and midpregnancy or with a change in levels of household/caregiving , occupational , and active living activities from prepregnancy to during pregnancy . However , after controlling for age and prepregnancy body mass index ( BMI ) , women in the highest quartile of prepregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.03 ) and midpregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.004 ) household/caregiving activities  as well as midpregnancy sports/exercise ( 0.1 , 95 % CI 0.0 - 0.7 , p(trend ) = 0.12 ) had a reduced risk of GDM compared with women in the lowest quartile . CONCLUSIONS Findings in this Hispanic population , although based on small numbers of cases , are consistent with prior research among predominantly non-Hispanic white population The study was design ed to identify those pregnant women who are diagnosed as having gestational diabetes by National Diabetes Data Group ( NDDG ) criteria , but normal glucose tolerance ( NGT ) or impaired glucose tolerance ( IGT ) by the World Health Organization ( WHO ) criteria , and to test whether treatment changed the perinatal outcome in those with NGT and IGT . The 216 women with an abnormal 100 g oral glucose tolerance test ( OGTT ) using NDDG criteria were subjected to a 75 g OGTT . Using the WHO criteria , 111 women ( 51 % ) had NGT , 98 ( 45 % ) had IGT and 7 ( 3 % ) had frank diabetes mellitus . Those with NGT and IGT were r and omized into control and treatment groups . The perinatal outcome in these two groups was comparable whether the NGT and IGT groups were analysed together or separately except , that in those who were treated for IGT , smaller babies were born one week earlier than in the control group ( 3407 g vs 3110 g , P less than 0.01 ) . This suggests that the WHO criteria can safely replace the 100 g OGTT with substantial savings in manpower , money and patients ' time 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 Background The impact of borderline gestational diabetes mellitus ( BGDM ) , defined as a positive oral glucose challenge test ( OGCT ) and normal oral glucose tolerance test ( OGTT ) , on maternal and infant health is unclear . We assessed maternal and infant health outcomes in women with BGDM and compared these to women who had a normal OGCT screen for gestational diabetes . Methods We compared demographic , obstetric and neonatal outcomes between women participating in the Australian Collaborative Trial of Supplements with antioxidants Vitamin C and Vitamin E to pregnant women for the prevention of pre-eclampsia ( ACTS ) who had BGDM and who screened negative on OGCT . Results Women who had BGDM were older ( mean difference 1.3 years , [ 95 % confidence interval ( CI ) 0.3 , 2.2 ] , p = 0.01 ) and more likely to be  obese  ( 27.1 % vs 14.1 % , relative risk ( RR ) 1.92 , [ 95 % CI 1.41 , 2.62 ] , p < 0.0001 ) than women who screened negative on OGCT . The risk of adverse maternal outcome overall was higher ( 12.9 % vs 8.1 % , RR 1.59 , [ 95 % CI 1.00 , 2.52 ] , p = 0.05 ) in women with BGDM compared with women with a normal OGCT . Women with BGDM were more likely to develop pregnancy induced hypertension ( 17.9 % vs 11.8 % , RR 1.51 , [ 95 % CI 1.03 , 2.20 ] , p = 0.03 ) , have a caesarean for fetal distress ( 17.1 % vs 10.5 % , RR 1.63 , [ 95 % CI 1.10 , 2.41 ] , p = 0.01 ) , and require a longer postnatal hospital stay ( mean difference 0.4 day , [ 95 % CI 0.1 , 0.7 ] , p = 0.01 ) than those with a normal glucose tolerance . Infants born to BGDM mothers were more likely to be born preterm ( 10.7 % vs 6.4 % , RR 1.68 , [ 95 % CI 1.00 , 2.80 ] , p = 0.05 ) , have macrosomia ( birthweight ≥4.5 kg ) ( 4.3 % vs 1.7 % , RR 2.53 , [ 95 % CI 1.06 , 6.03 ] , p = 0.04 ) , be admitted to the neonatal intensive care unit ( NICU ) ( 6.5 % vs 3.0 % , RR 2.18 , [ 95 % CI 1.09 , 4.36 ] , p = 0.03 ) or the neonatal nursery ( 40.3 % vs 28.4 % , RR 1.42 , [ 95 % CI 1.14 , 1.76 ] , p = 0.002 ) , and have a longer hospital stay ( p = 0.001 ) . More infants in the BGDM group had Sarnat stage 2 or 3 neonatal encephalopathy ( 12.9 % vs 7.8 % , RR 1.65 , [ 95 % CI 1.04 , 2.63 ] , p = 0.03 ) . Conclusion Women with BGDM and their infants had an increased risk of adverse health outcomes compared with women with a negative OGCT . Intervention strategies to reduce the risks for these women and their infants need evaluation . Trial registration Current Controlled Trials IS RCT OBJECTIVE To assess blood glucose control and neonatal outcomes when women with gestational diabetes mellitus ( GDM ) were treated with metformin or glyburide . METHODS When an appropriate diet was insufficient to control their blood glucose levels , women with GDM were r and omized to a glyburide or a metformin treatment group . If the maximum dose was reached , the assessed drug was replaced by insulin . The primary outcome measures analyzed were maternal glucose levels during pregnancy , birth weight , and neonatal gl 
    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: In this study , we assessed maternal-fetal outcomes in untreated patients with increasing carbohydrate intolerance not meeting the current criteria for the diagnosis of gestational diabetes mellitus ( GDM ) , examined the relationship between birth weight and mode of delivery among women with untreated borderline GDM , treated overt GDM , and normoglycemia , and established more efficient screening strategies for detection of GDM . This was a prospect i ve analytic cohort study in which nondiabetic women aged > or = 24 years were eligible for enrollment . A 50-g glucose challenge test ( GCT ) and a 100-g oral glucose tolerance test ( OGTT ) were administered at 26 and 28 weeks gestational age , respectively . Risk factors for unfavorable maternal-fetal outcomes were recorded . Time since the last meal  prior to the screening test was recorded , as well . Caregivers and patients were blinded to glucose values except when test results met the National Diabetes Data Group criteria for GDM . Maternal and fetal outcomes , including the mode of the delivery , were recorded in the postpartum period . Of 4,274 patients screened , 3,836 ( 90 % ) continued to the diagnostic oral glucose tolerance test . GDM was seen in 145 women . Increasing carbohydrate intolerance in women without overt gestational diabetes was associated with a significantly increased incidence of cesarean section , preeclampsia , macrosomia , and need for phototherapy , as well as an increased length of maternal and neonatal hospital stay . Multivariate analysis showed that increasing carbohydrate intolerance remained an independent predictor for various unfavorable outcomes , but the strength of the associations was diminished . Compared with normoglycemic control subjects , the untreated borderline GDM group had increased rates of macrosomia ( 28.7 vs. 13.7 % , P < 0.001 ) and cesarean delivery ( 29.6 vs. 20.2 % , P = 0.03 ) . Usual care of known GDM patients normalized birth weights , but the cesarean delivery rate was about 33 % , whether macrosomia was present or absent . An increased risk of cesarean delivery among treated patients compared with normoglycemic control subjects persisted after adjustment for multiple maternal risk factors . As for the screening tests , time since the last meal had a marked effect on mean plasma glucose . Receiver operating characteristic curve analysis allowed the selection of the most efficient cut points for the GCT based on the time since the last meal . These cut points were 8.2 , 7.9 , and 8.3 mmol/l ( 1 mmol/l = 18.015 mg/dl ) for elapsed postpr and ial time of < 2 , 2 - 3 , and > 3 h , respectively . With this change from the current threshold of 7.8 mmol/l , the number of patients with a positive screening test dropped from 18.5 to 13.7 % . There was an increase in positive predictive value from 14.4 to 18.7 % . The overall rate of patient misclassification fell from 18.0 to 13.1 % . In conclusion , increasing maternal carbohydrate intolerance in pregnant women without GDM is associated with a grade d increase in adverse maternal and fetal outcomes . Infant macrosomia is an important factor in high cesarean delivery rates for women with untreated borderline GDM . Although detection and treatment of GDM normalizes birth weights , rates of cesarean delivery remain inexplicably high . Recognition of GDM may lead to a lower threshold for surgical delivery . The efficiency of screening for GDM can be enhanced by adjusting the current GCT threshold of 7.8 mmol/l to new values related to time since the last meal before screening . Further analyses are underway to eluci date whether maternal risk factors can be used to achieve additional efficiency gains in screening OBJECTIVE Studies in predominantly non-Hispanic white population s have suggested that physical activity during pregnancy is associated with a reduced risk of gestational diabetes mellitus ( GDM ) . There are few such studies in Hispanic women , a group at increased risk for GDM . METHODS We conducted a prospect i ve cohort study of household/caregiving , occupational , sports/exercise , and active living habits and the risk of GDM among 1006 Hispanic ( predominantly Puerto Rican ) prenatal care patients in western Massachusetts from 2000 to 2004 . Prepregnancy , early pregnancy , and midpregnancy physical activity was assessed using the Kaiser Physical Activity Survey . RESULTS A total of 33 women ( 3.3 % ) were diagnosed with GDM , and 119 women ( 11.8 % ) were diagnosed with abnormal glucose tolerance . There were no significant associations between GDM risk and occupational and active living activities  in prepregnancy , early pregnancy , and midpregnancy or with a change in levels of household/caregiving , occupational , and active living activities from prepregnancy to during pregnancy . However , after controlling for age and prepregnancy body mass index ( BMI ) , women in the highest quartile of prepregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.03 ) and midpregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.004 ) household/caregiving activities  as well as midpregnancy sports/exercise ( 0.1 , 95 % CI 0.0 - 0.7 , p(trend ) = 0.12 ) had a reduced risk of GDM compared with women in the lowest quartile . CONCLUSIONS Findings in this Hispanic population , although based on small numbers of cases , are consistent with prior research among predominantly non-Hispanic white population The study was design ed to identify those pregnant women who are diagnosed as having gestational diabetes by National Diabetes Data Group ( NDDG ) criteria , but normal glucose tolerance ( NGT ) or impaired glucose tolerance ( IGT ) by the World Health Organization ( WHO ) criteria , and to test whether treatment changed the perinatal outcome in those with NGT and IGT . The 216 women with an abnormal 100 g oral glucose tolerance test ( OGTT ) using NDDG criteria were subjected to a 75 g OGTT . Using the WHO criteria , 111 women ( 51 % ) had NGT , 98 ( 45 % ) had IGT and 7 ( 3 % ) had frank diabetes mellitus . Those with NGT and IGT were r and omized into control and treatment groups . The perinatal outcome in these two groups was comparable whether the NGT and IGT groups were analysed together or separately except , that in those who were treated for IGT , smaller babies were born one week earlier than in the control group ( 3407 g vs 3110 g , P less than 0.01 ) . This suggests that the WHO criteria can safely replace the 100 g OGTT with substantial savings in manpower , money and patients ' time 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 Background The impact of borderline gestational diabetes mellitus ( BGDM ) , defined as a positive oral glucose challenge test ( OGCT ) and normal oral glucose tolerance test ( OGTT ) , on maternal and infant health is unclear . We assessed maternal and infant health outcomes in women with BGDM and compared these to women who had a normal OGCT screen for gestational diabetes . Methods We compared demographic , obstetric and neonatal outcomes between women participating in the Australian Collaborative Trial of Supplements with antioxidants Vitamin C and Vitamin E to pregnant women for the prevention of pre-eclampsia ( ACTS ) who had BGDM and who screened negative on OGCT . Results Women who had BGDM were older ( mean difference 1.3 years , [ 95 % confidence interval ( CI ) 0.3 , 2.2 ] , p = 0.01 ) and more likely to be  obese  ( 27.1 % vs 14.1 % , relative risk ( RR ) 1.92 , [ 95 % CI 1.41 , 2.62 ] , p < 0.0001 ) than women who screened negative on OGCT . The risk of adverse maternal outcome overall was higher ( 12.9 % vs 8.1 % , RR 1.59 , [ 95 % CI 1.00 , 2.52 ] , p = 0.05 ) in women with BGDM compared with women with a normal OGCT . Women with BGDM were more likely to develop pregnancy induced hypertension ( 17.9 % vs 11.8 % , RR 1.51 , [ 95 % CI 1.03 , 2.20 ] , p = 0.03 ) , have a caesarean for fetal distress ( 17.1 % vs 10.5 % , RR 1.63 , [ 95 % CI 1.10 , 2.41 ] , p = 0.01 ) , and require a longer postnatal hospital stay ( mean difference 0.4 day , [ 95 % CI 0.1 , 0.7 ] , p = 0.01 ) than those with a normal glucose tolerance . Infants born to BGDM mothers were more likely to be born preterm ( 10.7 % vs 6.4 % , RR 1.68 , [ 95 % CI 1.00 , 2.80 ] , p = 0.05 ) , have macrosomia ( birthweight ≥4.5 kg ) ( 4.3 % vs 1.7 % , RR 2.53 , [ 95 % CI 1.06 , 6.03 ] , p = 0.04 ) , be admitted to the neonatal intensive care unit ( NICU ) ( 6.5 % vs 3.0 % , RR 2.18 , [ 95 % CI 1.09 , 4.36 ] , p = 0.03 ) or the neonatal nursery ( 40.3 % vs 28.4 % , RR 1.42 , [ 95 % CI 1.14 , 1.76 ] , p = 0.002 ) , and have a longer hospital stay ( p = 0.001 ) . More infants in the BGDM group had Sarnat stage 2 or 3 neonatal encephalopathy ( 12.9 % vs 7.8 % , RR 1.65 , [ 95 % CI 1.04 , 2.63 ] , p = 0.03 ) . Conclusion Women with BGDM and their infants had an increased risk of adverse health outcomes compared with women with a negative OGCT . Intervention strategies to reduce the risks for these women and their infants need evaluation . Trial registration Current Controlled Trials IS RCT OBJECTIVE To assess blood glucose control and neonatal outcomes when women with gestational diabetes mellitus ( GDM ) were treated with metformin or glyburide . METHODS When an appropriate diet was insufficient to control their blood glucose levels , women with GDM were r and omized to a glyburide or a metformin treatment group . If the maximum dose was reached , the assessed drug was replaced by insulin . The primary outcome measures analyzed were maternal glucose levels during pregnancy , birth weight , and neonatal gl 
    Output:
    