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: Objectives . To compare a walking exercise to a stretching exercise during pregnancy in high-risk women who were sedentary and had previously experienced preeclampsia . Methods . A r and omized clinical trial of the effects of the two types of physical exercises was conducted between November 2001 and July 2006 in Washtenaw County , Michigan . Both groups engaged in the assigned exercise five times a week until the end of pregnancy . Results . Women were r and omized to either the walking group ( n = 41 ) or the stretching group ( n = 38 ) . The walkers exercised an average of 36 ( SD , 6 ) minutes at 18 weeks gestation , 34 ( SD , 7 ) minutes at 28 weeks gestation , and 31 ( SD , 12 ) minutes at the last week of the intervention . On average , they exercised within target heart rate ranges 35 % ( SD , 32 % ) at 18 weeks gestation , 22 % ( SD , 25 % ) at 28 weeks gestation , and 17 % ( SD , 25 % ) at the last week of the intervention . The stretching group engaged in stretching exercises following a 40-minutes videotape . On average , the walking group exercised 4 ( SD , 1 ) times a week at 18 weeks gestation , 4 ( SD , 1 ) time a week at 28 weeks gestation , and 3 ( SD , 1 ) times a week at the last week of the intervention . Equally on average , the stretching group exercised 4 ( SD , 2 ) times a week at 18 weeks gestation , 5 ( SD , 1 ) times a week at 28 weeks gestation , and 3 ( SD , 1 ) times a week at the last week of the intervention . No difference between groups was observed , but both exercised significantly less frequently over the time ( p < 0.0001 ) . Together , participants reported average 7,040 ( SD , 2,612 ) steps at the beginning and 5,711 ( SD , 2,739 ) steps at the end of the study . The walkers tracked an average 8,501 ( SE , 778 ) steps a day at 20 weeks gestation and 7,418 ( SE , 788 ) steps at 34 weeks gestation ( n.s . ) . The stretchers tracked an average 6,189 ( SE , 704 ) steps at 20 weeks gestation and 4,848 ( SE , 452 ) steps at 34 weeks gestation ( p < 0.05 ) . The incidence of preeclampsia was 14.6 % ( 95 % CI , 5.6 to 29.2 ) among the walkers and 2.6 % ( 95 % CI ; 0.07 to 13.8 ) among the stretchers . The incidence of gestational hypertension was 22 % ( 95 % C.I. , 8.7 to 35.2 ) for the walkers and 40 % ( 95 % CI , 23.2 to 55.8 ) for the stretchers . The mean transferrin level , an antioxidant marker , was significantly higher in the stretching group mean ( 412 mg/dL , 95%CI , 389 to 435 ) than the walkers at the time of labor ( mean = 368 mg/dL , 95%CI , 346 to 391 ) ( p < 0.05 ) . No significant group differences were observed in birth outcomes . Conclusion . Regular stretching exercises may promote endogenous antioxidants among women at risk for preeclampsia Background To evaluate the effectiveness and safety of water aerobics during pregnancy . Methods A r and omized controlled trial carried out in 71 low-risk sedentary pregnant women , r and omly allocated to water aerobics or no physical exercise .  Maternal body composition and perinatal outcomes were evaluated . For statistical analysis Chi-square , Fisher 's or Student 's t-tests were applied . Risk ratios and their 95 % CI were estimated for main outcomes . Body composition was evaluated across time using MANOVA or Friedman multiple analysis . Results There were no significant differences between the groups regarding maternal weight gain , BMI or percentage of body fat during pregnancy . Incidence of preterm births ( RR = 0.84 ; 95%CI:0.28–2.53 ) , vaginal births ( RR = 1.24 ; 95%CI:0.73–2.09 ) , low birthweight ( RR = 1.30 ; 95%CI:0.61–2.79 ) and adequate weight for gestational age ( RR = 1.50 ; 95%CI:0.65–3.48 ) were also not significantly different between groups . There were no significant differences in systolic and diastolic blood pressure and heart rate between before and immediately after the water aerobics session . Conclusion Water aerobics for sedentary pregnant women proved to be safe and was not associated with any alteration in maternal body composition , type of delivery , preterm birth rate , neonatal well-being or weight Diabetes in pregnancy is a major public health problem in Mexico .  Nutrition therapy is an important component of treatment . Intensive nutrition intervention has not been implemented for Mexican pregnant women with diabetes . Its effect on different types of diabetes mellitus has not been studied . Purpose The authors assessed the effect of a medical nutrition therapy ( MNT ) program on perinatal complications in Mexico City . Methods Quasi-experimental design with a historical control . Women were assigned to a MNT program ( n = 88 ) and were followed up with every 2 weeks until delivery ( 2004 - 2007 ) . The control group ( n = 86 ) was selected from medical charts ( 2001 - 2003 ) and the same inclusion criteria were used . In each group , 55 % of women had type 2 diabetes mellitus and 45 % had gestational diabetes . The MNT program included a moderate intake of carbohydrate ( 40%-45 % of total energy ) and reduction in energy intake , capillary glucose self-monitoring , and education . The control group received usual hospital routine care . Statistical analysis included descriptive statistics , chi-square , and multivariate logistic regression ( OR , 95 % CI ) as indicated . Results Women in the MNT program had a lower risk of preeclampsia , fewer maternal hospitalization , and neonatal deaths in both types of diabetes . Low birth weight was less frequent only in women with gestational diabetes receiving MNT , while neonatal intensive care unit admissions were lower only in women with type 2 diabetes . Conclusions An intensive MNT program , including counseling , education , and capillary glucose self-monitoring , has a positive effect over preeclampsia , maternal hospitalization , and neonatal death in women with diabetes in pregnancy . MNT guidelines should be implemented in Mexican health care facilities treating diabetes in pregnancy The histomorphometry of term placentae from women who exercised regularly throughout either the first half or all of pregnancy was compared to that of placentae from matched controls to determine if regular exercise during pregnancy produced histomorphometric evidence of altered development and transport capacity . Conventional stereological techniques were used to estimate placental volumetric composition , surface areas , and villous and vascular configurations in the three groups . Exercise confined to early pregnancy increased the parenchymal component of the placenta , total vascular volume and site-specific capillary volume and surface area .  Exercise throughout pregnancy increased these and multiple other histomorphometric parameters associated with the rate of placental perfusion and transfer function . However , significant changes were confined to villi > 80 microns in diameter . The localization of both the timing of the stimulus and the anatomical sites affected indicates that regular , sustained exercise modifies placental development primarily in early and mid-pregnancy . We speculate that the lack of significant changes in the structure and configuration of the smaller villi indicates that other adaptive mechanisms , such as increased rates of placental blood flow , must be well developed by the latter portion of the mid-trimester and adequately maintain fetal oxygenation and substrate delivery throughout the third trimester OBJECTIVE To evaluate the influence of exercise on maternal and perinatal outcome in a low‐risk healthy obstetric population . METHODS We conducted a prospect i ve observational study of low‐risk healthy women exercising during their pregnancy . An extensive question naire collected antepartum , intrapartum , and postpartum patient information on 750 women . The women were divided into four groups based on exercise level during pregnancy . RESULTS There were no differences among groups for maternal demographic characteristics , antenatal illnesses , stress , social support , or smoking . Heavily exercising women were older ( P = .042 ) , had higher incomes ( P = .001 ) , and were exercising more at conception ( P = .001 ) . Women who did more exercise were more likely to need an induction of labor ( P = .033 , relative risk 1.84 , 95 % confidence interval 1.05 , 3.20 ) , induction or augmentation with oxytocin ( P = .015 , relative risk 1.53 , 95 % confidence interval 1.19 , 1.97 ) , and had longer first‐stage labors ( P = .032 ) result ing in longer total labors ( P = .011 ) . The difference in the length of first‐stage labor was even greater if the no‐exercise group was compared with the strongly exercising group ( P = .009 , relative risk 1.38 , 95 % confidence interval 0.16 , 2.60 ) . Fewer umbilical cord abnormalities ( P = .034 ) were observed with exercise , but exercising women had more colds and flu ( P = .008 ) . Heavily exercising women had smaller infants ( mean difference 86.5 g ) compared with sedentary women . CONCLUSION Exercise  in working women is associated with smaller babies , increased number of inductions and augmentations of labor , and longer labors . Colds and flu are more frequent in exercising women OBJECTIVES The purpose of this project was to develop a detailed , in-home , prenatal nutrition intervention protocol for low-income women and to assess the effectiveness of the intervention in improving their dietary intake . A secondary objective was to identify predictors of infant birth weight . DESIGN A defined protocol was developed and nutritionists followed it to conduct in-home nutrition sessions that included nutrition assessment , education , counseling , and goal setting for low-income women during their pregnancies . A pre/post design was used to assess the effects of the nutrition program on dietary intake . A control group was used in evaluating the effect of the nutrition intervention on birth weight . SUBJECTS/ SETTING Forty low-income pregnant women selected r and omly by the county health department nursing staff completed the nutrition intervention . Twenty-six women were also selected to serve as a control group . INTERVENTION For women in the intervention group , in-home visits were conducted weekly for 4 weeks , followed by 2 monthly visits . The purpose of the in-home visits was to use the defined protocol , which included monitoring weight gain and providing individualized dietary intake assessment and nutrition education and counseling . MAIN OUTCOME MEASURES The primary outcome measures were change in dietary intake from preintervention to postintervention , mothers ' weight at time of delivery , and infant birth weight . STATISTICAL ANALYSIS PERFORMED Paired t tests were used to compare the women 's mean daily energy and nutrient intakes before and after the nutrition intervention . Correlation analysis identified relationships between infant birth weight and independent variables , and multiple stepwise regression analysis was used to identify variables that contributed to the variation in infant birth weight . Mean birth weight was compared in the intervention and control groups by means of a t test . A chi 2 test was used for categoric variables . RESULTS Comparison of dietary intakes before and after the intervention revealed significant increases in total energy ( 2,269 to 2,431 kcal , P < .05 ) , folate ( 345 to 412 micrograms , P < .01 ) , vitamin B-6 ( 2.1 to 2.5 mg , P < .01 ) , iron ( 17.5 to 21.2 mg , P < .01 ) , zinc ( 13.6 to 14.7 mg , P < .01 ) , and calcium ( 1,175 mg to 1,299 mg , P < .01 ) and significant ( P < .01 ) increases in daily servings from the vegetable group ( 1.5 + /- 1.0 to 2.2 + /- 1.1 serving per day ) and breads/grains groups ( 3.4 + /- 1.4 to 4.1 + /- 1.5 servings per day ) . There was no significant difference in mean birth weight between the intervention and control groups . Sixty-five percent of the variation in infant birth weight was accounted for by mother 's weight at time of delivery , pre-pregnancy body mass index , number of visits by the nutritionist , and change in energy intake from preintervention to postintervention . APPLICATIONS This defined , in-home , prenatal nutrition intervention protocol can be used by providers of prenatal nutrition services to document outcomes of prenatal nutrition care in high-risk women . Use of a defined protocol will facilitate collection of meaningful outcomes data by service providers OBJECTIVE To determine if an interactive , computerized Video Doctor counseling tool improves self-reported diet and exercise in pregnant women . METHODS A r and omized trial comparing a Video Doctor intervention to usual care in ethnically diverse , low-income , English-speaking pregnant women was conducted . Brief messages about diet , exercise 
    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: Objectives . To compare a walking exercise to a stretching exercise during pregnancy in high-risk women who were sedentary and had previously experienced preeclampsia . Methods . A r and omized clinical trial of the effects of the two types of physical exercises was conducted between November 2001 and July 2006 in Washtenaw County , Michigan . Both groups engaged in the assigned exercise five times a week until the end of pregnancy . Results . Women were r and omized to either the walking group ( n = 41 ) or the stretching group ( n = 38 ) . The walkers exercised an average of 36 ( SD , 6 ) minutes at 18 weeks gestation , 34 ( SD , 7 ) minutes at 28 weeks gestation , and 31 ( SD , 12 ) minutes at the last week of the intervention . On average , they exercised within target heart rate ranges 35 % ( SD , 32 % ) at 18 weeks gestation , 22 % ( SD , 25 % ) at 28 weeks gestation , and 17 % ( SD , 25 % ) at the last week of the intervention . The stretching group engaged in stretching exercises following a 40-minutes videotape . On average , the walking group exercised 4 ( SD , 1 ) times a week at 18 weeks gestation , 4 ( SD , 1 ) time a week at 28 weeks gestation , and 3 ( SD , 1 ) times a week at the last week of the intervention . Equally on average , the stretching group exercised 4 ( SD , 2 ) times a week at 18 weeks gestation , 5 ( SD , 1 ) times a week at 28 weeks gestation , and 3 ( SD , 1 ) times a week at the last week of the intervention . No difference between groups was observed , but both exercised significantly less frequently over the time ( p < 0.0001 ) . Together , participants reported average 7,040 ( SD , 2,612 ) steps at the beginning and 5,711 ( SD , 2,739 ) steps at the end of the study . The walkers tracked an average 8,501 ( SE , 778 ) steps a day at 20 weeks gestation and 7,418 ( SE , 788 ) steps at 34 weeks gestation ( n.s . ) . The stretchers tracked an average 6,189 ( SE , 704 ) steps at 20 weeks gestation and 4,848 ( SE , 452 ) steps at 34 weeks gestation ( p < 0.05 ) . The incidence of preeclampsia was 14.6 % ( 95 % CI , 5.6 to 29.2 ) among the walkers and 2.6 % ( 95 % CI ; 0.07 to 13.8 ) among the stretchers . The incidence of gestational hypertension was 22 % ( 95 % C.I. , 8.7 to 35.2 ) for the walkers and 40 % ( 95 % CI , 23.2 to 55.8 ) for the stretchers . The mean transferrin level , an antioxidant marker , was significantly higher in the stretching group mean ( 412 mg/dL , 95%CI , 389 to 435 ) than the walkers at the time of labor ( mean = 368 mg/dL , 95%CI , 346 to 391 ) ( p < 0.05 ) . No significant group differences were observed in birth outcomes . Conclusion . Regular stretching exercises may promote endogenous antioxidants among women at risk for preeclampsia Background To evaluate the effectiveness and safety of water aerobics during pregnancy . Methods A r and omized controlled trial carried out in 71 low-risk sedentary pregnant women , r and omly allocated to water aerobics or no physical exercise .  Maternal body composition and perinatal outcomes were evaluated . For statistical analysis Chi-square , Fisher 's or Student 's t-tests were applied . Risk ratios and their 95 % CI were estimated for main outcomes . Body composition was evaluated across time using MANOVA or Friedman multiple analysis . Results There were no significant differences between the groups regarding maternal weight gain , BMI or percentage of body fat during pregnancy . Incidence of preterm births ( RR = 0.84 ; 95%CI:0.28–2.53 ) , vaginal births ( RR = 1.24 ; 95%CI:0.73–2.09 ) , low birthweight ( RR = 1.30 ; 95%CI:0.61–2.79 ) and adequate weight for gestational age ( RR = 1.50 ; 95%CI:0.65–3.48 ) were also not significantly different between groups . There were no significant differences in systolic and diastolic blood pressure and heart rate between before and immediately after the water aerobics session . Conclusion Water aerobics for sedentary pregnant women proved to be safe and was not associated with any alteration in maternal body composition , type of delivery , preterm birth rate , neonatal well-being or weight Diabetes in pregnancy is a major public health problem in Mexico .  Nutrition therapy is an important component of treatment . Intensive nutrition intervention has not been implemented for Mexican pregnant women with diabetes . Its effect on different types of diabetes mellitus has not been studied . Purpose The authors assessed the effect of a medical nutrition therapy ( MNT ) program on perinatal complications in Mexico City . Methods Quasi-experimental design with a historical control . Women were assigned to a MNT program ( n = 88 ) and were followed up with every 2 weeks until delivery ( 2004 - 2007 ) . The control group ( n = 86 ) was selected from medical charts ( 2001 - 2003 ) and the same inclusion criteria were used . In each group , 55 % of women had type 2 diabetes mellitus and 45 % had gestational diabetes . The MNT program included a moderate intake of carbohydrate ( 40%-45 % of total energy ) and reduction in energy intake , capillary glucose self-monitoring , and education . The control group received usual hospital routine care . Statistical analysis included descriptive statistics , chi-square , and multivariate logistic regression ( OR , 95 % CI ) as indicated . Results Women in the MNT program had a lower risk of preeclampsia , fewer maternal hospitalization , and neonatal deaths in both types of diabetes . Low birth weight was less frequent only in women with gestational diabetes receiving MNT , while neonatal intensive care unit admissions were lower only in women with type 2 diabetes . Conclusions An intensive MNT program , including counseling , education , and capillary glucose self-monitoring , has a positive effect over preeclampsia , maternal hospitalization , and neonatal death in women with diabetes in pregnancy . MNT guidelines should be implemented in Mexican health care facilities treating diabetes in pregnancy The histomorphometry of term placentae from women who exercised regularly throughout either the first half or all of pregnancy was compared to that of placentae from matched controls to determine if regular exercise during pregnancy produced histomorphometric evidence of altered development and transport capacity . Conventional stereological techniques were used to estimate placental volumetric composition , surface areas , and villous and vascular configurations in the three groups . Exercise confined to early pregnancy increased the parenchymal component of the placenta , total vascular volume and site-specific capillary volume and surface area .  Exercise throughout pregnancy increased these and multiple other histomorphometric parameters associated with the rate of placental perfusion and transfer function . However , significant changes were confined to villi > 80 microns in diameter . The localization of both the timing of the stimulus and the anatomical sites affected indicates that regular , sustained exercise modifies placental development primarily in early and mid-pregnancy . We speculate that the lack of significant changes in the structure and configuration of the smaller villi indicates that other adaptive mechanisms , such as increased rates of placental blood flow , must be well developed by the latter portion of the mid-trimester and adequately maintain fetal oxygenation and substrate delivery throughout the third trimester OBJECTIVE To evaluate the influence of exercise on maternal and perinatal outcome in a low‐risk healthy obstetric population . METHODS We conducted a prospect i ve observational study of low‐risk healthy women exercising during their pregnancy . An extensive question naire collected antepartum , intrapartum , and postpartum patient information on 750 women . The women were divided into four groups based on exercise level during pregnancy . RESULTS There were no differences among groups for maternal demographic characteristics , antenatal illnesses , stress , social support , or smoking . Heavily exercising women were older ( P = .042 ) , had higher incomes ( P = .001 ) , and were exercising more at conception ( P = .001 ) . Women who did more exercise were more likely to need an induction of labor ( P = .033 , relative risk 1.84 , 95 % confidence interval 1.05 , 3.20 ) , induction or augmentation with oxytocin ( P = .015 , relative risk 1.53 , 95 % confidence interval 1.19 , 1.97 ) , and had longer first‐stage labors ( P = .032 ) result ing in longer total labors ( P = .011 ) . The difference in the length of first‐stage labor was even greater if the no‐exercise group was compared with the strongly exercising group ( P = .009 , relative risk 1.38 , 95 % confidence interval 0.16 , 2.60 ) . Fewer umbilical cord abnormalities ( P = .034 ) were observed with exercise , but exercising women had more colds and flu ( P = .008 ) . Heavily exercising women had smaller infants ( mean difference 86.5 g ) compared with sedentary women . CONCLUSION Exercise  in working women is associated with smaller babies , increased number of inductions and augmentations of labor , and longer labors . Colds and flu are more frequent in exercising women OBJECTIVES The purpose of this project was to develop a detailed , in-home , prenatal nutrition intervention protocol for low-income women and to assess the effectiveness of the intervention in improving their dietary intake . A secondary objective was to identify predictors of infant birth weight . DESIGN A defined protocol was developed and nutritionists followed it to conduct in-home nutrition sessions that included nutrition assessment , education , counseling , and goal setting for low-income women during their pregnancies . A pre/post design was used to assess the effects of the nutrition program on dietary intake . A control group was used in evaluating the effect of the nutrition intervention on birth weight . SUBJECTS/ SETTING Forty low-income pregnant women selected r and omly by the county health department nursing staff completed the nutrition intervention . Twenty-six women were also selected to serve as a control group . INTERVENTION For women in the intervention group , in-home visits were conducted weekly for 4 weeks , followed by 2 monthly visits . The purpose of the in-home visits was to use the defined protocol , which included monitoring weight gain and providing individualized dietary intake assessment and nutrition education and counseling . MAIN OUTCOME MEASURES The primary outcome measures were change in dietary intake from preintervention to postintervention , mothers ' weight at time of delivery , and infant birth weight . STATISTICAL ANALYSIS PERFORMED Paired t tests were used to compare the women 's mean daily energy and nutrient intakes before and after the nutrition intervention . Correlation analysis identified relationships between infant birth weight and independent variables , and multiple stepwise regression analysis was used to identify variables that contributed to the variation in infant birth weight . Mean birth weight was compared in the intervention and control groups by means of a t test . A chi 2 test was used for categoric variables . RESULTS Comparison of dietary intakes before and after the intervention revealed significant increases in total energy ( 2,269 to 2,431 kcal , P < .05 ) , folate ( 345 to 412 micrograms , P < .01 ) , vitamin B-6 ( 2.1 to 2.5 mg , P < .01 ) , iron ( 17.5 to 21.2 mg , P < .01 ) , zinc ( 13.6 to 14.7 mg , P < .01 ) , and calcium ( 1,175 mg to 1,299 mg , P < .01 ) and significant ( P < .01 ) increases in daily servings from the vegetable group ( 1.5 + /- 1.0 to 2.2 + /- 1.1 serving per day ) and breads/grains groups ( 3.4 + /- 1.4 to 4.1 + /- 1.5 servings per day ) . There was no significant difference in mean birth weight between the intervention and control groups . Sixty-five percent of the variation in infant birth weight was accounted for by mother 's weight at time of delivery , pre-pregnancy body mass index , number of visits by the nutritionist , and change in energy intake from preintervention to postintervention . APPLICATIONS This defined , in-home , prenatal nutrition intervention protocol can be used by providers of prenatal nutrition services to document outcomes of prenatal nutrition care in high-risk women . Use of a defined protocol will facilitate collection of meaningful outcomes data by service providers OBJECTIVE To determine if an interactive , computerized Video Doctor counseling tool improves self-reported diet and exercise in pregnant women . METHODS A r and omized trial comparing a Video Doctor intervention to usual care in ethnically diverse , low-income , English-speaking pregnant women was conducted . Brief messages about diet , exercise 
    Output:
    