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: Overweight and obesity have significant implication s during pregnancy and childbirth . The objective of this review was to provide a comprehensive overview of the effect of physical activity on pregnancy outcomes , the change of  physical activity during pregnancy , and women ’s perception of being physically active during pregnancy , with a particular focus on women who are overweight or obese . Many studies have investigated the beneficial effect of exercise during pregnancy , including reduced risk of gestational diabetes , preeclampsia , and operative birth , in addition to improved cardiovascular function , overall fitness , psychological well-being , and mood stability . Benefits for the infant include reduced risks of prematurity and improved fetal growth , although there is more limited information about longer-term health benefits for both women and infants . The existing literature examining physical activity patterns during pregnancy has generally focused on women of all body mass index categories , consistently indicating a reduction in activity over the course of pregnancy . However , the available literature evaluating physical activity during pregnancy among women who are overweight or obese is more limited and contradictory . A number of studies identified barriers preventing women from being active during pregnancy , including pregnancy symptoms , lack of time , access to child care , and concerns about their safety and that of their unborn baby . Conversely , significant enablers included positive psychological feelings , family influence , and receiving advice from health professionals . Very few studies have provided insights about perceptions of being active during pregnancy in the overweight and obese population . There is a need for a detailed description of physical activity patterns during pregnancy in women who are overweight or obese , and more r and omized trials evaluating exercise interventions for women who are overweight or obese , with a focus on clinical outcomes Background Excessive  weight gain  during pregnancy is a major risk factor for macrosomia ( high birth weight delivery ) . This study aim ed to explore views about weight gain and lifestyle practice s during pregnancy among women with a history of macrosomia . Methods A qualitative descriptive study was conducted . Twenty-one second-time mothers whose first infant was macrosomic ( > 4 kg ) were recruited from a r and omised trial in a large maternity hospital in the Republic of Irel and .  Semi-structured interviews were conducted with participants at both 6 and 12 months after their second pregnancy . Inductive thematic analysis was used to identify distinct themes . Results The mothers believed in following their prenatal food cravings to meet their baby ’s needs , but this led some to eat excessively . Many of the women cut back heavily on physical activity during pregnancy due to perceived risks to the baby . Physical conditions and discomforts during pregnancy often limited maternal control over weight and lifestyle practice s. The women were not particularly concerned about weight gain during pregnancy and most did not favour the notion of introducing weight gain guidelines into routine antenatal care . Common differences perceived by the women between their first and second pregnancy included : increased concern about weight gain in their second pregnancy due to prior difficulties with postpartum weight loss and increased time dem and s in their second pregnancy impeded healthy lifestyle practice s. Most women did not alter their perspectives on weight gain and lifestyle practice s in their second pregnancy in response to having a macrosomic infant in their first pregnancy . Conclusions This analysis exposed numerous barriers to healthy pregnancy weight gain . The findings suggest that women may need to be advised to follow their prenatal food cravings in moderation . Pregnant women with children already may benefit from education on time-efficient methods of integrating healthy eating practice s and physical activity into their lifestyles . Women with a history of macrosomia may need information about the importance of avoiding high weight gain in subsequent pregnancies BACKGROUND Maternal age is a preponderant variable in the epidemiological analysis of the premature birth . Studies show that in the extreme ages of the maternal life there is a risk of premature birth that generates a high rate of neonatal morbidity . OBJECTIVES [ corrected ] Determine the effect on the extreme ages of women residents in the province of Alicante on the total of the premature births . METHOD An explanatory , retrospective case-control study was conducted during the period from January 1st , 2008 to December 31st , 2011 . The study was based on the revision of the newborn registers from the Neonatal Screening Center of the province of Alicante . All the preterm were included , this means between 22 & 36 complete weeks of pregnancy ( 5,295 out of 78,391 newborn which represents 6.75 % of prematurity ) , and a r and om sample of the deliveries with 37 weeks or more of pregnancy ( control group ) . The age of the mother was studied as independent variable and the prematurity as dependent variable . RESULTS Clearly shows an increased risk of prematurity among teenage mothers compared to the age group nearest to them , which is confirmed by a squared Chi test which gives a significantly different distribution ( p < 0,0001 ) and an OD for very preterm of 2,41 ( 1,51 - 3,24 ) and of preterm of 1,71 ( 1,32 - 2,19 ) . This probability is also higher among mothers over 40 years old with an OD of 1,86 ( 1,39 - 2,48 ) and 1,66 ( 1,44 - 1,91 ) for very preterm newborns and preterm newborns respectively . DISCUSSION The results clearly manifest that teenagers and older pregnant mothers are at higher prematurity and low birth weight risk , therefore imposes the need to trace educational interventions to minimize this problem from the results in this research OBJECTIVE the objective of the study was to compare the differences in psychological well-being and quality of life during pregnancy and post partum of obese physically active women and obese physically inactive women enroled in a weight gain restriction programme . We also wanted to explore whether physical activity influences weight change or health status during pregnancy . DESIGN a prospect i ve intervention study . SETTING antenatal care clinic . PARTICIPANTS a total of 74 obese pregnant women in a physically active group and 79 obese women in a physically inactive group . MEASUREMENTS the women kept diaries of their physical activity during pregnancy and answered the Beck Anxiety Inventory  , the Edinburgh Postnatal Depression Scale and Medical Study Short-Form Health Survey in gestational weeks 15 and 35 and 11 weeks post partum .  Physical activity  was measured in metabolic equivalents . FINDINGS the physically active women experienced fewer depressive symptoms and estimated an improved quality of life during their pregnancies as measured by physical functioning , bodily pain , social functioning , role limitations due to emotional problems and general mental health as compared with the physically inactive women . There were no differences between the groups in gestational weight gain or weight change from early pregnancy to post partum or in prevalence of complications . KEY CONCLUSIONS physical activity among obese pregnant women provides better psychological well-being and improved quality of life , but does not prevent weight change . IMPLICATION S FOR PRACTICE staff at Antenatal Care Clinics that face obese pregnant women , should encourage and emphasise the benefits of being physically active throughout pregnancy Background Complex interventions in obese pregnant women should be theoretically based , feasible and shown to demonstrate anticipated behavioural change prior to inception of large r and omised controlled trials ( RCTs ) . The aim was to determine if a ) a complex intervention in obese pregnant women leads to anticipated changes in diet and physical activity behaviours , and b ) to refine the intervention protocol through process evaluation of intervention fidelity . Methods We undertook a pilot RCT of a complex intervention in obese pregnant women , comparing routine antenatal care with an intervention to reduce dietary glycaemic load and saturated fat intake , and increase physical activity . Subjects included 183 obese pregnant women ( mean BMI 36.3 kg/m2).Diet was assessed by repeated triple pass 24-hour dietary recall and physical activity by accelerometry and question naire , at 16 + 0 to 18 + 6 and at 27 + 0 to 28 + 6 weeks ’ gestation in women in control and intervention arms . Attitudes to behaviour change and quality of life were assessed and a process evaluation undertaken . The full RCT protocol was undertaken to assess feasibility . Results Compared to women in the control arm , women in the intervention arm had a significant reduction in dietary glycaemic load ( 33 points , 95 % CI −47 to −20 ) , ( p < 0.001 ) and saturated fat intake ( −1.6 % energy , 95 % CI −2.8 to −0 . 3 ) at 28 weeks ’ gestation . Objective ly measured physical activity did not change . Physical discomfort and sustained barriers to physical activity were common at 28 weeks ’ gestation . Process evaluation identified barriers to recruitment , group attendance and compliance , leading to modification of intervention delivery . Conclusions This pilot trial of a complex intervention in obese pregnant women suggests greater potential for change in dietary intake than for change in physical activity , and through process evaluation illustrates the considerable advantage of performing an exploratory trial of a complex intervention in obese pregnant women before undertaking a large RCT .Trial registration Trial Registration Number : IS RCT The aim of this study was to examine the predictors of change in intensity-specific leisure-time physical activity ( LTPA ) during pregnancy , and the perceived support and barriers of LTPA in Finnish pregnant women at increased risk of gestational diabetes . The study population consisted of 399 pregnant women who participated in a r and omized controlled trial aim ing to prevent gestational diabetes . Evaluation of LTPA was based on a self-report at baseline , 26–28 , and 36–37 weeks ’ gestation . Data on predictors of change , perceived support and barriers were collected with question naires and from the maternity cards . Multinomial logistic regression was used to assess associations between the variables . The average weekly minutes of light-intensity LTPA were 179 at baseline , 161 at 26–28 weeks ’ gestation , and 179 at 36–37 weeks ’ gestation . The corresponding minutes of moderate-to-vigorous-intensity LTPA were 187 , 133 and 99 . At 26–28 weeks ’ gestation , the strongest predictors for light-intensity LTPA were meeting the PA recommendations prior to pregnancy , having polytechnic education and working part-time , while having a physically active spouse prior to pregnancy was the strongest predictor for moderate-to-vigorous-intensity LTPA . The people and /or factors that encouraged women to LTPA the most were the spouse , a child , other family members and weather , whereas tiredness , nausea , perceived health , work and lack of time restricted their LTPA the most . The strongest predictors for maintaining LTPA during pregnancy were pre-pregnancy LTPA , education , working part-time and a spouse ’s LTPA . Most common barriers were perceived health , work and lack of time Background Gestational diabetes mellitus ( GDM ) is increasing worldwide and has been associated with adverse perinatal outcomes and high risk for chronic disease both for the mother and for the child . Physical exercise is feasible for diabetic pregnant women and contributes to better glycemic control and to a decrease in adverse perinatal outcomes . However , there are no r and omized controlled trials ( RCT ) assessing the effects of aquatic physical exercise on GDM control and adverse maternal and fetal outcomes . Methods / Design An RCT will be conducted at Instituto de Medicina Integral Prof Fern and o Figueira ( IMIP ) , Brazil . A total of 72 pregnant women will be studied ; 36 gestational diabetics will undergo an aquatic physical exercise program in a thermal pool , 3 times per week over 2 months . The primary endpoint will be glucose level control and use of insulin ; secondary endpoints will be the following maternal and fetal outcomes : weight gain during pregnancy , blood pressure , pre-eclampsia diagnosis , intrauterus growth restriction , preterm birth , Cesarean section , macrosomia and maternal or neonatal intensive care admission . Endpoints between intervention and control group will analyzed by t test for unpaired data and χ2 test , and the level of significance will set at < 0.05 . Discussion The physical proprieties of water make aquatic exercises ideal for pregnant women . An aquatic physical exercise program developed for GDM women will be trialed in a thermal pool and under the supervision of physiotherapist to ensure compliance . It is expected that this study will provide evidence as to the effect of aquatic physical exercise on GDM control . Trial registration Clinical Trial.gov , NCT01940003 Background Recent studies suggest that excessive gestational weight gain ( GWG ) leads to adverse maternal and fetal outcomes including weight retention in the mother and an increased risk of childhood obesity in the offspring . The aim of the GeliS study is to examine the effect of a lifestyle intervention programme during pregnancy to avoid excessive GWG and , hence , to reduce pregnancy and obstetric complications as well as the risk of maternal and offspring obesity . Methods and design The GeliS study is a multicentre cluster-r and omized controlled trial . A total number of 2500 pregnant women ( singleton pregnancy ) with a pre-pregnancy BMI ≥ 18.5 kg/m2 and ≤ 40 kg/m2 will be recruited in practice s of gynaecologists and midwives in ten Bavarian regions . The intervention comprises three structured and individualised counselling sessions on a healthy diet , regular physical activity as well as weight monitoring during pregnancy and one session after delivery , respectively . The counselling sessions are attached to routine pre- and postnatal visits using st and ardised material s and procedures . In the control regions , general recommendations for a healthy lifest 
    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: Overweight and obesity have significant implication s during pregnancy and childbirth . The objective of this review was to provide a comprehensive overview of the effect of physical activity on pregnancy outcomes , the change of  physical activity during pregnancy , and women ’s perception of being physically active during pregnancy , with a particular focus on women who are overweight or obese . Many studies have investigated the beneficial effect of exercise during pregnancy , including reduced risk of gestational diabetes , preeclampsia , and operative birth , in addition to improved cardiovascular function , overall fitness , psychological well-being , and mood stability . Benefits for the infant include reduced risks of prematurity and improved fetal growth , although there is more limited information about longer-term health benefits for both women and infants . The existing literature examining physical activity patterns during pregnancy has generally focused on women of all body mass index categories , consistently indicating a reduction in activity over the course of pregnancy . However , the available literature evaluating physical activity during pregnancy among women who are overweight or obese is more limited and contradictory . A number of studies identified barriers preventing women from being active during pregnancy , including pregnancy symptoms , lack of time , access to child care , and concerns about their safety and that of their unborn baby . Conversely , significant enablers included positive psychological feelings , family influence , and receiving advice from health professionals . Very few studies have provided insights about perceptions of being active during pregnancy in the overweight and obese population . There is a need for a detailed description of physical activity patterns during pregnancy in women who are overweight or obese , and more r and omized trials evaluating exercise interventions for women who are overweight or obese , with a focus on clinical outcomes Background Excessive  weight gain  during pregnancy is a major risk factor for macrosomia ( high birth weight delivery ) . This study aim ed to explore views about weight gain and lifestyle practice s during pregnancy among women with a history of macrosomia . Methods A qualitative descriptive study was conducted . Twenty-one second-time mothers whose first infant was macrosomic ( > 4 kg ) were recruited from a r and omised trial in a large maternity hospital in the Republic of Irel and .  Semi-structured interviews were conducted with participants at both 6 and 12 months after their second pregnancy . Inductive thematic analysis was used to identify distinct themes . Results The mothers believed in following their prenatal food cravings to meet their baby ’s needs , but this led some to eat excessively . Many of the women cut back heavily on physical activity during pregnancy due to perceived risks to the baby . Physical conditions and discomforts during pregnancy often limited maternal control over weight and lifestyle practice s. The women were not particularly concerned about weight gain during pregnancy and most did not favour the notion of introducing weight gain guidelines into routine antenatal care . Common differences perceived by the women between their first and second pregnancy included : increased concern about weight gain in their second pregnancy due to prior difficulties with postpartum weight loss and increased time dem and s in their second pregnancy impeded healthy lifestyle practice s. Most women did not alter their perspectives on weight gain and lifestyle practice s in their second pregnancy in response to having a macrosomic infant in their first pregnancy . Conclusions This analysis exposed numerous barriers to healthy pregnancy weight gain . The findings suggest that women may need to be advised to follow their prenatal food cravings in moderation . Pregnant women with children already may benefit from education on time-efficient methods of integrating healthy eating practice s and physical activity into their lifestyles . Women with a history of macrosomia may need information about the importance of avoiding high weight gain in subsequent pregnancies BACKGROUND Maternal age is a preponderant variable in the epidemiological analysis of the premature birth . Studies show that in the extreme ages of the maternal life there is a risk of premature birth that generates a high rate of neonatal morbidity . OBJECTIVES [ corrected ] Determine the effect on the extreme ages of women residents in the province of Alicante on the total of the premature births . METHOD An explanatory , retrospective case-control study was conducted during the period from January 1st , 2008 to December 31st , 2011 . The study was based on the revision of the newborn registers from the Neonatal Screening Center of the province of Alicante . All the preterm were included , this means between 22 & 36 complete weeks of pregnancy ( 5,295 out of 78,391 newborn which represents 6.75 % of prematurity ) , and a r and om sample of the deliveries with 37 weeks or more of pregnancy ( control group ) . The age of the mother was studied as independent variable and the prematurity as dependent variable . RESULTS Clearly shows an increased risk of prematurity among teenage mothers compared to the age group nearest to them , which is confirmed by a squared Chi test which gives a significantly different distribution ( p < 0,0001 ) and an OD for very preterm of 2,41 ( 1,51 - 3,24 ) and of preterm of 1,71 ( 1,32 - 2,19 ) . This probability is also higher among mothers over 40 years old with an OD of 1,86 ( 1,39 - 2,48 ) and 1,66 ( 1,44 - 1,91 ) for very preterm newborns and preterm newborns respectively . DISCUSSION The results clearly manifest that teenagers and older pregnant mothers are at higher prematurity and low birth weight risk , therefore imposes the need to trace educational interventions to minimize this problem from the results in this research OBJECTIVE the objective of the study was to compare the differences in psychological well-being and quality of life during pregnancy and post partum of obese physically active women and obese physically inactive women enroled in a weight gain restriction programme . We also wanted to explore whether physical activity influences weight change or health status during pregnancy . DESIGN a prospect i ve intervention study . SETTING antenatal care clinic . PARTICIPANTS a total of 74 obese pregnant women in a physically active group and 79 obese women in a physically inactive group . MEASUREMENTS the women kept diaries of their physical activity during pregnancy and answered the Beck Anxiety Inventory  , the Edinburgh Postnatal Depression Scale and Medical Study Short-Form Health Survey in gestational weeks 15 and 35 and 11 weeks post partum .  Physical activity  was measured in metabolic equivalents . FINDINGS the physically active women experienced fewer depressive symptoms and estimated an improved quality of life during their pregnancies as measured by physical functioning , bodily pain , social functioning , role limitations due to emotional problems and general mental health as compared with the physically inactive women . There were no differences between the groups in gestational weight gain or weight change from early pregnancy to post partum or in prevalence of complications . KEY CONCLUSIONS physical activity among obese pregnant women provides better psychological well-being and improved quality of life , but does not prevent weight change . IMPLICATION S FOR PRACTICE staff at Antenatal Care Clinics that face obese pregnant women , should encourage and emphasise the benefits of being physically active throughout pregnancy Background Complex interventions in obese pregnant women should be theoretically based , feasible and shown to demonstrate anticipated behavioural change prior to inception of large r and omised controlled trials ( RCTs ) . The aim was to determine if a ) a complex intervention in obese pregnant women leads to anticipated changes in diet and physical activity behaviours , and b ) to refine the intervention protocol through process evaluation of intervention fidelity . Methods We undertook a pilot RCT of a complex intervention in obese pregnant women , comparing routine antenatal care with an intervention to reduce dietary glycaemic load and saturated fat intake , and increase physical activity . Subjects included 183 obese pregnant women ( mean BMI 36.3 kg/m2).Diet was assessed by repeated triple pass 24-hour dietary recall and physical activity by accelerometry and question naire , at 16 + 0 to 18 + 6 and at 27 + 0 to 28 + 6 weeks ’ gestation in women in control and intervention arms . Attitudes to behaviour change and quality of life were assessed and a process evaluation undertaken . The full RCT protocol was undertaken to assess feasibility . Results Compared to women in the control arm , women in the intervention arm had a significant reduction in dietary glycaemic load ( 33 points , 95 % CI −47 to −20 ) , ( p < 0.001 ) and saturated fat intake ( −1.6 % energy , 95 % CI −2.8 to −0 . 3 ) at 28 weeks ’ gestation . Objective ly measured physical activity did not change . Physical discomfort and sustained barriers to physical activity were common at 28 weeks ’ gestation . Process evaluation identified barriers to recruitment , group attendance and compliance , leading to modification of intervention delivery . Conclusions This pilot trial of a complex intervention in obese pregnant women suggests greater potential for change in dietary intake than for change in physical activity , and through process evaluation illustrates the considerable advantage of performing an exploratory trial of a complex intervention in obese pregnant women before undertaking a large RCT .Trial registration Trial Registration Number : IS RCT The aim of this study was to examine the predictors of change in intensity-specific leisure-time physical activity ( LTPA ) during pregnancy , and the perceived support and barriers of LTPA in Finnish pregnant women at increased risk of gestational diabetes . The study population consisted of 399 pregnant women who participated in a r and omized controlled trial aim ing to prevent gestational diabetes . Evaluation of LTPA was based on a self-report at baseline , 26–28 , and 36–37 weeks ’ gestation . Data on predictors of change , perceived support and barriers were collected with question naires and from the maternity cards . Multinomial logistic regression was used to assess associations between the variables . The average weekly minutes of light-intensity LTPA were 179 at baseline , 161 at 26–28 weeks ’ gestation , and 179 at 36–37 weeks ’ gestation . The corresponding minutes of moderate-to-vigorous-intensity LTPA were 187 , 133 and 99 . At 26–28 weeks ’ gestation , the strongest predictors for light-intensity LTPA were meeting the PA recommendations prior to pregnancy , having polytechnic education and working part-time , while having a physically active spouse prior to pregnancy was the strongest predictor for moderate-to-vigorous-intensity LTPA . The people and /or factors that encouraged women to LTPA the most were the spouse , a child , other family members and weather , whereas tiredness , nausea , perceived health , work and lack of time restricted their LTPA the most . The strongest predictors for maintaining LTPA during pregnancy were pre-pregnancy LTPA , education , working part-time and a spouse ’s LTPA . Most common barriers were perceived health , work and lack of time Background Gestational diabetes mellitus ( GDM ) is increasing worldwide and has been associated with adverse perinatal outcomes and high risk for chronic disease both for the mother and for the child . Physical exercise is feasible for diabetic pregnant women and contributes to better glycemic control and to a decrease in adverse perinatal outcomes . However , there are no r and omized controlled trials ( RCT ) assessing the effects of aquatic physical exercise on GDM control and adverse maternal and fetal outcomes . Methods / Design An RCT will be conducted at Instituto de Medicina Integral Prof Fern and o Figueira ( IMIP ) , Brazil . A total of 72 pregnant women will be studied ; 36 gestational diabetics will undergo an aquatic physical exercise program in a thermal pool , 3 times per week over 2 months . The primary endpoint will be glucose level control and use of insulin ; secondary endpoints will be the following maternal and fetal outcomes : weight gain during pregnancy , blood pressure , pre-eclampsia diagnosis , intrauterus growth restriction , preterm birth , Cesarean section , macrosomia and maternal or neonatal intensive care admission . Endpoints between intervention and control group will analyzed by t test for unpaired data and χ2 test , and the level of significance will set at < 0.05 . Discussion The physical proprieties of water make aquatic exercises ideal for pregnant women . An aquatic physical exercise program developed for GDM women will be trialed in a thermal pool and under the supervision of physiotherapist to ensure compliance . It is expected that this study will provide evidence as to the effect of aquatic physical exercise on GDM control . Trial registration Clinical Trial.gov , NCT01940003 Background Recent studies suggest that excessive gestational weight gain ( GWG ) leads to adverse maternal and fetal outcomes including weight retention in the mother and an increased risk of childhood obesity in the offspring . The aim of the GeliS study is to examine the effect of a lifestyle intervention programme during pregnancy to avoid excessive GWG and , hence , to reduce pregnancy and obstetric complications as well as the risk of maternal and offspring obesity . Methods and design The GeliS study is a multicentre cluster-r and omized controlled trial . A total number of 2500 pregnant women ( singleton pregnancy ) with a pre-pregnancy BMI ≥ 18.5 kg/m2 and ≤ 40 kg/m2 will be recruited in practice s of gynaecologists and midwives in ten Bavarian regions . The intervention comprises three structured and individualised counselling sessions on a healthy diet , regular physical activity as well as weight monitoring during pregnancy and one session after delivery , respectively . The counselling sessions are attached to routine pre- and postnatal visits using st and ardised material s and procedures . In the control regions , general recommendations for a healthy lifest 
    Output:
    