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: It is recognized that women with gestational diabetes mellitus ( GDM ) who have significantly elevated fasting blood glucose levels are at increased risk for fetal macrosomia and perinatal morbidity if treatment is not provided ( 1,2 ) . The association of milder forms of GDM with perinatal morbidity and mortality remains unclear , primarily because the condition is often confounded with other risk factors such as maternal obesity , age , and parity . Screening for GDM is recommended for most pregnant women , yet it is unknown whether there is a benefit to the identification and treatment of mild carbohydrate intolerance during pregnancy ( 3,4 ) . The present report is an up date of our previous description of a current ongoing r and omized treatment trial for mild GDM ( 5 ) . A r and omized clinical trial of women with mild GDM ( fasting glucose < 95 mg/dl ) is being undertaken that compares perinatal outcomes in those receiving diet therapy and insulin as required versus those r and omized to no specific treatment . This study aims to clarify whether there is utility in identifying and treating women with a normal fasting glucose level who meet st and ard criteria for GDM . We plan to compare perinatal outcomes in women who have been r and omized to diet and /or insulin therapy with women who have been r and omized to no specific treatment . A r and omized treatment trial of mild GDM will clarify whether identification and treatment of mild GDM reduce perinatal morbidity . This information will assist in determining appropriate thresholds for the treatment of GDM . Overall , with broader identification and aggressive treatment , perinatal mortality rates associated with GDM appear to be similar to the nondiabetic population ( 1 ) . Several analyses of 20 years ago did document an increased stillbirth rate for GDM pregnancies that would qualify as preexisting diabetes according to World Health Organization criteria ( 6–9 ) . Below this threshold , the extent to Please cite this paper as : Ijäs H , Vääräsmäki M , Morin‐Papunen L , Keravuo R , Ebeling T , Saarela T , Raudaskoski T. Metformin should be considered in the treatment of gestational diabetes : a prospect i ve r and omised study . BJOG 2011;118:880–885 PURPOSE The purpose of this study was to examine the effects of self-monitoring of blood glucose ( SMBG ) on feelings of self-efficacy , dietary compliance , and pregnancy outcomes in women with diet-controlled gestational diabetes mellitus ( GDM ) . METHODS Fifty-eight women with GDM and a fasting blood glucose level < 95 mg/dL were r and omly assigned to 2 groups . The experimental group measured their blood glucose levels 4 times daily using a reflectance meter with memory . Metabolic status  was assessed in the control group by periodic monitoring at prenatal visits . Otherwise the management protocol was identical for both groups . The Diabetes Empowerment Scale was completed at study entry and at 37 weeks gestation to assess feelings of self-efficacy .  Dietary compliance was assessed at each visit . RESULTS Both groups of women achieved excellent glucose control ; only 1 woman in each group required insulin therapy . There were no significant differences with regard to feelings of self-efficacy , dietary compliance , birth weight , gestational age at delivery , Apgar scores , and neonatal complications . Rates of macrosomia , delivery by cesarean section , and occurrence of birth trauma were similar . CONCLUSIONS SMBG appears to have little effect on maternal feelings of self-efficacy , dietary compliance , or pregnancy outcomes in women with diet-controlled GDM The aim of this study was to determine whether amniotic fluid insulin concentration ( AFI ) is a better parameter than mean maternal blood glucose values ( MBG ) for deciding about insulin therapy in patients with gestational diabetes . MBG 's were calculated on the base of 9 blood glucose levels during a 24 hour period after one week of diet therapy . In a prospect i ve trial between 1987 and 1989 in Karlsburg , 123 gestational diabetic patients were r and omized into two groups . Treatment was either based on the concentration of AFI or MBG levels . In a second series in Berlin , 103 patients were offered amniocentesis . 81 patients agreed and 22 refused . Treatment was then analogous to that in Karlsburg . In both groups of the r and omized population , strict metabolic control was achieved . There was no difference regarding pregnancy complications . Earlier labor induction and higher cesarean section rates were seen in the non-invasive group ( p < 0.05 ) . The incidence of diabetic fetopathy and neonatal hypoglycemia was significantly lower in the invasive group ( p < 0.01 ) , even though the metabolic control parameters did not differ between the two groups . The results in Berlin correspond to these findings . In conclusion , AFI enables the recognition of any hyperinsulinism reaction to the maternal metabolic situation . We recommend the additional measurement of the AFI concentration between 28 and 36 weeks as the direct fetal parameter for deciding about insulin treatment 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 Aim The efficacy and safety of insulin aspart ( IAsp ) , a rapid-acting human insulin analogue , were compared with regular human insulin ( HI ) as the bolus component of basal-bolus therapy for subjects with gestational diabetes mellitus ( GDM ) . Methods In a r and omized , parallel-group , open-labelled trial , 27 women with GDM ( age 30.7 ± 6.3 years , HbA1c < 7 % ) were r and omized to receive IAsp ( 5 min before meal ) or HI ( 30 min before meal ) . The trial period extended from diagnosis of GDM ( 18–28 weeks ) to 6 weeks postpartum . Results Both treatment groups maintained good overall glycaemic control during the study ( beginning and end of study HbA1c≤ 6 % ) . During the meal test , mean glucose at week 6 ( IAsp 4.2 ± 0.57 mmol/l , HI 4.8 ± 0.86 mmol/l ) was slightly lower than at week 0 ( IAsp 4.9 ± 0.59 mmol/l , HI 5.1 ± 0.36 mmol/l ) . However , change from baseline values for average glucose ( IAsp –1.09 ± 0.54 mmol/l , HI –0.54 ± 0.74 mmol/l ; P = 0.003 ) and C-peptide ( IAsp –0.50 ± 0.67 nmol/l , HI –0.30 ± 0.70 nmol/l ; P = 0.027 ) were significantly lower after IAsp treatment than HI treatment . No major hypoglycaemic events were reported during the study . Cross-reacting insulin antibody binding increased slightly from baseline in both treatments groups ( end of study : IAsp 2.1 ± 5.4 % , HI 6.4 ± 13.9 % ) , whereas antibodies specific to IAsp or HI remained relatively low ( < 1 % binding ) . Conclusion IAsp was more effective than HI in decreasing postpr and ial glucose concentrations . Duration of IAsp injection 5 min before a meal rather than 30 min prior to meals offers a more convenient therapy for subjects with GDM . Overall safety and effectiveness of IAsp were comparable to HI in pregnant women with GDM . Diabet . Med . 24 , 1129–1135 ( 2007 Background Mild gestational diabetes is a common complication of pregnancy , affecting up to 9 % of pregnant women . Treatment of mild GDM is known to reduce adverse perinatal outcomes such as macrosomia and associated birth injuries , such as shoulder dystocia , bone fractures and nerve palsies . This study aim ed to compare the plasma glucose concentrations and serum insulin , leptin and adiponectin in cord blood of babies of women ( a ) without gestational diabetes mellitus ( GDM ) , ( b ) with mild GDM under routine care , or ( c ) mild GDM with treatment . Methods 95 women with mild GDM on oral glucose tolerance testing ( OGTT ) at one tertiary level maternity hospital who had been recruited to the ACHOIS trial at one of the collaborating hospitals and r and omised to either Treatment ( n = 46 ) or Routine Care ( n = 49 ) and Control women with a normal OGTT ( n = 133 ) were included in the study . Women with mild GDM ( treatment or routine care group ) and OGTT normal women received routine pregnancy care . In addition , women with treated mild GDM received dietary advice , blood glucose monitoring and insulin if necessary . The primary outcome measures were cord blood concentrations of glucose , insulin , adiponectin and leptin . Results Cord plasma glucose was higher in women receiving routine care compared with control , but was normalized by treatment for mild GDM ( p = 0.01 ) . Cord serum insulin and insulin to glucose ratio were similar between the three groups . Leptin concentration in cord serum was lower in GDM treated women compared with routine care ( p = 0.02 ) and not different to control ( p = 0.11 ) . Adiponectin was lower in both mild GDM groups compared with control ( Treatment p = 0.02 and Routine Care p = 0.07 ) , while the adiponectin to leptin ratio was lower for women receiving routine care compared with treatment ( p = 0.08 ) and control ( p = 0.05 ) . Conclusion Treatment of women with mild GDM using diet , blood glucose monitoring and insulin if necessary , influences the altered fetal adipoinsular axis characteristic of mild GDM in pregnancy OBJECTIVES The purpose of this study was to determine whether strict maternal glycemic control for the treatment of gestational diabetes lessened the risk of fetal macrosomia , birth trauma , neonatal hypoglycemia , and operative delivery . The aim of the pilot study was to prepare for a multicenter trial by assessing patient acceptance of the study , by determining realistic accrual rates , and by detecting any major adverse outcomes in the control group that received routine obstetric care . STUDY DESIGN The study was a prospect i ve r and omized controlled trial comparing fetal-neonatal and maternal outcomes in 300 women with gestational diabetes . Women r and omized to the treatment arm were managed by strict glycemic control and tertiary level obstetric care , and women in the control arm received routine obstetric care . RESULTS Three hundred women with gestational diabetes mellitus were studied . There was no difference in maternal age , weight , or length of gestation between groups . The treatment mean birth weight was 3437 + /- 575 gm compared with 3544 + /- 601 gm in the control group , a difference of 107 gm ( not significant ) . Macrosomia rates were similar . There was no birth trauma in either group . The frequency of neonatal hypoglycemia and other metabolic complications was the same . The mode of delivery also showed similar patterns . The treatment group had significantly lower prepr and ial and postpr and ial glucose levels by 32 weeks ' gestation , which continued to term . CONCLUSION This pilot study suggests that intensive treatment of gestational diabetes mellitus may have little effect on birth weight , birth trauma , operative delivery , or neonatal metabolic disorders . It has demonstrated the safety of proceeding to a multicenter trial of sufficient sample size to confirm these findings 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 ; 
    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: It is recognized that women with gestational diabetes mellitus ( GDM ) who have significantly elevated fasting blood glucose levels are at increased risk for fetal macrosomia and perinatal morbidity if treatment is not provided ( 1,2 ) . The association of milder forms of GDM with perinatal morbidity and mortality remains unclear , primarily because the condition is often confounded with other risk factors such as maternal obesity , age , and parity . Screening for GDM is recommended for most pregnant women , yet it is unknown whether there is a benefit to the identification and treatment of mild carbohydrate intolerance during pregnancy ( 3,4 ) . The present report is an up date of our previous description of a current ongoing r and omized treatment trial for mild GDM ( 5 ) . A r and omized clinical trial of women with mild GDM ( fasting glucose < 95 mg/dl ) is being undertaken that compares perinatal outcomes in those receiving diet therapy and insulin as required versus those r and omized to no specific treatment . This study aims to clarify whether there is utility in identifying and treating women with a normal fasting glucose level who meet st and ard criteria for GDM . We plan to compare perinatal outcomes in women who have been r and omized to diet and /or insulin therapy with women who have been r and omized to no specific treatment . A r and omized treatment trial of mild GDM will clarify whether identification and treatment of mild GDM reduce perinatal morbidity . This information will assist in determining appropriate thresholds for the treatment of GDM . Overall , with broader identification and aggressive treatment , perinatal mortality rates associated with GDM appear to be similar to the nondiabetic population ( 1 ) . Several analyses of 20 years ago did document an increased stillbirth rate for GDM pregnancies that would qualify as preexisting diabetes according to World Health Organization criteria ( 6–9 ) . Below this threshold , the extent to Please cite this paper as : Ijäs H , Vääräsmäki M , Morin‐Papunen L , Keravuo R , Ebeling T , Saarela T , Raudaskoski T. Metformin should be considered in the treatment of gestational diabetes : a prospect i ve r and omised study . BJOG 2011;118:880–885 PURPOSE The purpose of this study was to examine the effects of self-monitoring of blood glucose ( SMBG ) on feelings of self-efficacy , dietary compliance , and pregnancy outcomes in women with diet-controlled gestational diabetes mellitus ( GDM ) . METHODS Fifty-eight women with GDM and a fasting blood glucose level < 95 mg/dL were r and omly assigned to 2 groups . The experimental group measured their blood glucose levels 4 times daily using a reflectance meter with memory . Metabolic status  was assessed in the control group by periodic monitoring at prenatal visits . Otherwise the management protocol was identical for both groups . The Diabetes Empowerment Scale was completed at study entry and at 37 weeks gestation to assess feelings of self-efficacy .  Dietary compliance was assessed at each visit . RESULTS Both groups of women achieved excellent glucose control ; only 1 woman in each group required insulin therapy . There were no significant differences with regard to feelings of self-efficacy , dietary compliance , birth weight , gestational age at delivery , Apgar scores , and neonatal complications . Rates of macrosomia , delivery by cesarean section , and occurrence of birth trauma were similar . CONCLUSIONS SMBG appears to have little effect on maternal feelings of self-efficacy , dietary compliance , or pregnancy outcomes in women with diet-controlled GDM The aim of this study was to determine whether amniotic fluid insulin concentration ( AFI ) is a better parameter than mean maternal blood glucose values ( MBG ) for deciding about insulin therapy in patients with gestational diabetes . MBG 's were calculated on the base of 9 blood glucose levels during a 24 hour period after one week of diet therapy . In a prospect i ve trial between 1987 and 1989 in Karlsburg , 123 gestational diabetic patients were r and omized into two groups . Treatment was either based on the concentration of AFI or MBG levels . In a second series in Berlin , 103 patients were offered amniocentesis . 81 patients agreed and 22 refused . Treatment was then analogous to that in Karlsburg . In both groups of the r and omized population , strict metabolic control was achieved . There was no difference regarding pregnancy complications . Earlier labor induction and higher cesarean section rates were seen in the non-invasive group ( p < 0.05 ) . The incidence of diabetic fetopathy and neonatal hypoglycemia was significantly lower in the invasive group ( p < 0.01 ) , even though the metabolic control parameters did not differ between the two groups . The results in Berlin correspond to these findings . In conclusion , AFI enables the recognition of any hyperinsulinism reaction to the maternal metabolic situation . We recommend the additional measurement of the AFI concentration between 28 and 36 weeks as the direct fetal parameter for deciding about insulin treatment 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 Aim The efficacy and safety of insulin aspart ( IAsp ) , a rapid-acting human insulin analogue , were compared with regular human insulin ( HI ) as the bolus component of basal-bolus therapy for subjects with gestational diabetes mellitus ( GDM ) . Methods In a r and omized , parallel-group , open-labelled trial , 27 women with GDM ( age 30.7 ± 6.3 years , HbA1c < 7 % ) were r and omized to receive IAsp ( 5 min before meal ) or HI ( 30 min before meal ) . The trial period extended from diagnosis of GDM ( 18–28 weeks ) to 6 weeks postpartum . Results Both treatment groups maintained good overall glycaemic control during the study ( beginning and end of study HbA1c≤ 6 % ) . During the meal test , mean glucose at week 6 ( IAsp 4.2 ± 0.57 mmol/l , HI 4.8 ± 0.86 mmol/l ) was slightly lower than at week 0 ( IAsp 4.9 ± 0.59 mmol/l , HI 5.1 ± 0.36 mmol/l ) . However , change from baseline values for average glucose ( IAsp –1.09 ± 0.54 mmol/l , HI –0.54 ± 0.74 mmol/l ; P = 0.003 ) and C-peptide ( IAsp –0.50 ± 0.67 nmol/l , HI –0.30 ± 0.70 nmol/l ; P = 0.027 ) were significantly lower after IAsp treatment than HI treatment . No major hypoglycaemic events were reported during the study . Cross-reacting insulin antibody binding increased slightly from baseline in both treatments groups ( end of study : IAsp 2.1 ± 5.4 % , HI 6.4 ± 13.9 % ) , whereas antibodies specific to IAsp or HI remained relatively low ( < 1 % binding ) . Conclusion IAsp was more effective than HI in decreasing postpr and ial glucose concentrations . Duration of IAsp injection 5 min before a meal rather than 30 min prior to meals offers a more convenient therapy for subjects with GDM . Overall safety and effectiveness of IAsp were comparable to HI in pregnant women with GDM . Diabet . Med . 24 , 1129–1135 ( 2007 Background Mild gestational diabetes is a common complication of pregnancy , affecting up to 9 % of pregnant women . Treatment of mild GDM is known to reduce adverse perinatal outcomes such as macrosomia and associated birth injuries , such as shoulder dystocia , bone fractures and nerve palsies . This study aim ed to compare the plasma glucose concentrations and serum insulin , leptin and adiponectin in cord blood of babies of women ( a ) without gestational diabetes mellitus ( GDM ) , ( b ) with mild GDM under routine care , or ( c ) mild GDM with treatment . Methods 95 women with mild GDM on oral glucose tolerance testing ( OGTT ) at one tertiary level maternity hospital who had been recruited to the ACHOIS trial at one of the collaborating hospitals and r and omised to either Treatment ( n = 46 ) or Routine Care ( n = 49 ) and Control women with a normal OGTT ( n = 133 ) were included in the study . Women with mild GDM ( treatment or routine care group ) and OGTT normal women received routine pregnancy care . In addition , women with treated mild GDM received dietary advice , blood glucose monitoring and insulin if necessary . The primary outcome measures were cord blood concentrations of glucose , insulin , adiponectin and leptin . Results Cord plasma glucose was higher in women receiving routine care compared with control , but was normalized by treatment for mild GDM ( p = 0.01 ) . Cord serum insulin and insulin to glucose ratio were similar between the three groups . Leptin concentration in cord serum was lower in GDM treated women compared with routine care ( p = 0.02 ) and not different to control ( p = 0.11 ) . Adiponectin was lower in both mild GDM groups compared with control ( Treatment p = 0.02 and Routine Care p = 0.07 ) , while the adiponectin to leptin ratio was lower for women receiving routine care compared with treatment ( p = 0.08 ) and control ( p = 0.05 ) . Conclusion Treatment of women with mild GDM using diet , blood glucose monitoring and insulin if necessary , influences the altered fetal adipoinsular axis characteristic of mild GDM in pregnancy OBJECTIVES The purpose of this study was to determine whether strict maternal glycemic control for the treatment of gestational diabetes lessened the risk of fetal macrosomia , birth trauma , neonatal hypoglycemia , and operative delivery . The aim of the pilot study was to prepare for a multicenter trial by assessing patient acceptance of the study , by determining realistic accrual rates , and by detecting any major adverse outcomes in the control group that received routine obstetric care . STUDY DESIGN The study was a prospect i ve r and omized controlled trial comparing fetal-neonatal and maternal outcomes in 300 women with gestational diabetes . Women r and omized to the treatment arm were managed by strict glycemic control and tertiary level obstetric care , and women in the control arm received routine obstetric care . RESULTS Three hundred women with gestational diabetes mellitus were studied . There was no difference in maternal age , weight , or length of gestation between groups . The treatment mean birth weight was 3437 + /- 575 gm compared with 3544 + /- 601 gm in the control group , a difference of 107 gm ( not significant ) . Macrosomia rates were similar . There was no birth trauma in either group . The frequency of neonatal hypoglycemia and other metabolic complications was the same . The mode of delivery also showed similar patterns . The treatment group had significantly lower prepr and ial and postpr and ial glucose levels by 32 weeks ' gestation , which continued to term . CONCLUSION This pilot study suggests that intensive treatment of gestational diabetes mellitus may have little effect on birth weight , birth trauma , operative delivery , or neonatal metabolic disorders . It has demonstrated the safety of proceeding to a multicenter trial of sufficient sample size to confirm these findings 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 ; 
    Output:
    