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: A r and omized clinical trial examined the efficiency and tolerability of twice weekly versus daily iron supplementation during pregnancy . A total of 370 pregnant women were r and omly assigned to receive either daily or twice weekly iron supplementation  during pregnancy . There were no significant differences in initial and delivery haemoglobin and haematocrit levels between the 2 groups . Ferritin concentrations were significantly lower in the twice weekly group at delivery , but hypoferritinaemia ( ferritin < 15 microg/L ) was not observed in either group . The frequency of nausea , vomiting and constipation were significantly lower in the twice weekly group . Birth weight and length were significantly higher in the daily supplemented group . In non-anaemic mothers , a smaller dose of iron may be sufficient and also might prevent the complications of iron excess Previous studies have found that there is a correlation between mothers ' haemoglobin concentration or packed cell volume and infants ' birth weight , and that iron supplementation increases mothers ' haemoglobin concentration . The purpose of this study , using the data of a large r and omised trial on iron prophylaxis during pregnancy , was to find out whether iron supplementation causes fetal growth to deteriorate . At their first antenatal visit , 2912 pregnant women were r and omised into non-routine iron and routine iron supplementation . The mean length of gestation was shorter in the non-routine group . Birth weight did not differ between the groups , but due to longer gestations boys in the group receiving routine iron were taller than in the non-routine group . In both groups , whether studied by various values of packed cell volume or correlation coefficients , the lower the packed cell volume , the heavier and taller the infant and heavier the placenta . These negative correlations could be seen even with a packed cell volume measured early in pregnancy . St and ardising for blood pressure did not influence the correlation coefficients . The correlation between a high ratio for packed cell volume and poor fetal growth thus may not be caused by iron supplementation , nor mediated by blood pressure , but by some other mechanism OBJECTIVE : To determine the impact of iron deficiency anemia ( IDA ) in pregnancy on young child development . METHODS : A 2-year follow-up of 850 children born to women who participated in a double-blind cluster r and omized controlled trial of prenatal micronutrient supplementation in western rural China . These women were r and omly assigned to receive either daily folic acid , iron/folic acid ( 60 mg iron ) , or multiple micronutrients ( with 30 mg iron ) during pregnancy . Children were categorized into the prenatal-IDA and prenatal – non-IDA groups based on the mother ’s hemoglobin in the third trimester . Each group contained 3 subgroups based on mother ’s treatment : folic acid , iron/folic acid , and multiple micronutrients .  Bayley scales of infant development were administered to the children to assess their development at 3 , 6 , 12 , 18 , and 24 months of age . RESULTS : Compared with the prenatal – non-IDA group , the prenatal-IDA group showed a significantly lower mental development index at 12 , 18 , and 24 months of age . The adjusted mean difference was 5.8 ( 95 % confidence interval [ CI ] , 1.1–10.5 ) , 5.1 ( 95 % CI , 1.2–9.0 ) , and 5.3 ( 95 % CI , 0.9–9.7 ) , respectively . Further analysis showed that the mental development indexes in the prenatal-IDA group and prenatal – non-IDA group were similar with supplementation of iron/folic acid but were significantly lower in the prenatal-IDA group with supplementation of folic acid or multiple micronutrients . CONCLUSIONS : Prenatal IDA in the third trimester is associated with mental development of the child . However , prenatal supplementation with sufficient iron protects child development even when the woman ’s IDA was not properly corrected in pregnancy Background Gastrointestinal irritability can deter pregnant women from starting or continuing prenatal multivitamin supplementation . In a previous study , suboptimal tolerability was observed among pregnant women taking a large tablet ( 18 mm × 8 mm × 8 mm ) multivitamin with high elemental iron content ( 60 mg as ferrous fumarate ) . The objective of the present study was to compare rates of adherence and reported adverse events among pregnant women who were r and omized to commence supplementation with a small-tablet prenatal multivitamin , containing either low or high iron content . Methods Pregnant women who called the Motherisk Program ( Hospital for Sick Children , Toronto ) and had not started taking or had discontinued any multivitamin due to adverse events were included in this prospect i ve , r and omized , open-label , 2-arm study . Women were r and omized to take a small-size ( 16 mm × 9 mm × 4 mm ) , low elemental iron content ( 35 mg as ferrous fumarate ) multivitamin ( ' 35 mg ' group ) ; or a small-size ( 5 mm radius , 5 mm thickness ) , high elemental iron content ( 60 mg as ferrous sulphate ) multivitamin ( ' 60 mg ' group ) . Follow-up interviews documented pill intake and adverse events . Rates of adherence and adverse events were compared between groups using chi-squared tests and Kaplan-Meier survival curves . Results Of 167 r and omized women , 92 in the ' 35 mg ' group and 75 in the ' 60 mg ' group were included in the analysis . Despite ideal conditions and regular follow-ups , mean adherence based on pill intake recall , in both groups was approximately 50 % . No statistically significant difference was detected in proportions of women who actually started taking either multivitamin . Among those who started , no difference was detected in rates of adherence or reported adverse events . Conclusion The present results suggest that iron content is not a major determinant of adherence to prenatal multivitamins . Combined with our previous study , tablet size may be the more definitive factor affecting adherence Two hundred Hausa primigravidae at Zaria were divided into five groups in a r and omized double-blind trial of antenatal oral antimalarial prophylaxis , and haematinic supplements . Group 1 received no active treatment . Groups 2 to 5 were given chloroquine 600 mg base once , followed by proguanil 100 mg per day . In addition , group 3 received iron 60 mg daily , group 4 folic acid 1 mg daily , and group 5 iron plus folic acid .  Forty-five percent were anaemic ( haemoglobin ( Hb ) less than 11.0 g dl-1 ) at first attendance before 24 weeks of gestation , and malaria parasitaemia ( predominantly Plasmodium falciparum ) was seen in 27 % , of whom 60 % were anaemic . The mean Hb fell during pregnancy in group 1 , and seven patients in this group had to be removed from the trial and treated for severe anaemia ( packed cell volume ( PCV ) less than 0.26 ) . Only five patients in the other groups developed severe anaemia ( P = 0.006 ) , two of whom had malaria following failure to take treatment . Patients in group 1 had the lowest mean Hb at 28 and 36 weeks of gestation , and patients receiving antimalarials and iron ( groups 3 and 5 ) had the highest Hb at 28 weeks , but differences were not significant , possibly due to removal from the trial of patients with severe anaemia . Anaemia ( Hb less than 12.0 g dl-1 ) at six weeks after delivery was observed in 61 % of those not receiving active treatment ( group 1 ) , in 39 % of those protected against malaria but not receiving iron supplements ( groups 2 and 4 ) and in only 18 % of patients receiving both antimalarials and iron ( groups 3 and 5 ) . Folic acid had no significant effect on mean Hb .  Proguanil was confirmed to be a highly effective causal prophylaxis . Prevention of malaria , without folic acid supplements , reduced the frequency of megaloblastic erythropoiesis from 56 % to 25 % . Folic acid supplements abolished megaloblastosis , except in three patients who were apparently not taking the treatment prescribed . Red cell folate ( RCF ) concentrations were higher in subjects with malaria , probably due to intracellular synthesis by plasmodia . Infants of mothers not receiving antimalarials appeared to have an erythroid hyperplasia . Maternal folate supplements raised infants ' serum folate and RCF .  Fourteen per cent had low birth weight ( less than 2500 g ) , and the perinatal death rate was 11 % ; the greatest number were in group 1 , but not significantly . A regime is proposed for the prevention of malaria , iron deficiency , folate deficiency and anaemia in pregnancy in the guinea savanna of Nigeria Background Prenatal micronutrient combinations with high iron content are associated with high rates of gastrointestinal symptoms . This coupled with nausea and vomiting of pregnancy results in women often discontinuing their multivitamins . A new prescription supplement ( PregVit ® ) that separates iron from calcium in two tablets – morning and evening , has lower elemental iron content ( 35 mg ) , but results in similar extent of iron absorption when compared to another supplement containing ( 60 mg ) of elemental iron ( Materna ® ) . The objectives of this study were to compare tolerability and compliance with PregVit ® vs. a supplement with high iron content ( Materna ® ) , in pregnant women . Methods R and omized , crossover open labeled study in 135 pregnant women attending outpatient clinics in Ontario and Quebec . Results Use of PregVit ® was associated with a 30 % reduction in constipation rate as compared to Materna ® . Both products demonstrated similar compliance rates . Compliance of Materna ® was negatively associated with the severity of nausea and vomiting of pregnancy . No such correlation was found for PregVvit ® . Conclusion PregVit ® , a supplement with lower iron content ( 35 mg ) , has significantly decreased constipation rates as compared to 60 mg iron- Materna and has similar compliance rates . High iron content in multivitamin supplements is associated with adverse effects in pregnancy Iron absorption from four prenatal multivitamin/multimineral preparations was compared in 36 healthy pregnant women in their second or third trimester of pregnancy . The products studied were the currently marketed formulations of Stuartnatal 1 + 1 , Stuart Prenatal , Materna , and Natalins Rx . Each fasted subject received each of the four preparations , according to a r and omized sequence , at intervals of three to seven days between drug administrations . Stuartnatal 1 + 1 demonstrated the best iron absorption . Total iron absorbed from Stuartnatal 1 + 1 and Stuart Prenatal was well above the additional daily 3.5 mg recommended during pregnancy . Following administration of Materna the amount of iron was only slightly above that recommended , and following Natalins Rx it was well below . All formulations were generally well tolerated by the subjects Background The purpose of this study was compare of daily iron supplementation in three time frames- daily , weekly and three time weekly supplementation in preventing anemia in healthy pregnant women . Method The present study was a prospect i ve simply r and omized clinical trial . During January 2006- January 2008 , 150 healthy pregnant women without anemia , in their 16th week of pregnancy were r and omly allocated into three equal groups . The first group ( n = 50 ) received a 50 mg-ferrous sulfate tablet daily , second group ( n = 50 ) received a 50 mg-ferrous sulfate tablet three times a week , and the third group ( n = 50 ) received two 50 mg-ferrous sulfate tablets ( 100 mg ) weekly , respectively for 12 consecutive weeks . Serum hemoglobin , ferritin , and iron were measured before and after the supplementation . Paired t and ANOVA tests were used as appropriated . Results There were no significant differences between the pre- and post-treatment hemoglobin levels with iron supplementation in the three group ( P = 0.518 , P = 0.276 , respectively ) . The mean serum iron level before and after treatment with iron supplementation in the three groups was not statistically significant ( P = 0.962 , P = 0.970 , respectively ) . Although the mean serum ferritin level before and after treatment with iron supplementation was statistically significant in the three groups , no significant differences were found comparing the three groups ( P = 0.827 , P = 0.635 respectively ) . Conclusions This results suggested , three times a week or weekly iron supplementation is as effective as daily supplementation for healthy pregnant women without anemia . Trial Registration IS RCT N : I RCT OBJECTIVE To evaluate whether levels of iron status markers ( haemoglobin , serum transferrin saturation , serum ferritin ) in pregnant women , measured in the beginning of the second trimester , could be used to predict levels later in pregnancy , pre partum and post partum . DESIGN R and omized , double-blind , placebo-controlled parallel study . SETTING The Birth Clinic at the Department of Obstetrics , Herning Hospital , Herning , Denmark . SUBJECTS One hundred and twenty healthy pregnant women between 14 and 18 weeks of gestation . INTERVENTIONS Sixty-three women were allocated to treatment with tablets containing 66 mg ferrous iron ( as fumarate ) daily , and 57 women to treatment with placebo . MAIN OUTCOME MEASURES Haemoglobin , serum transfer 
    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: A r and omized clinical trial examined the efficiency and tolerability of twice weekly versus daily iron supplementation during pregnancy . A total of 370 pregnant women were r and omly assigned to receive either daily or twice weekly iron supplementation  during pregnancy . There were no significant differences in initial and delivery haemoglobin and haematocrit levels between the 2 groups . Ferritin concentrations were significantly lower in the twice weekly group at delivery , but hypoferritinaemia ( ferritin < 15 microg/L ) was not observed in either group . The frequency of nausea , vomiting and constipation were significantly lower in the twice weekly group . Birth weight and length were significantly higher in the daily supplemented group . In non-anaemic mothers , a smaller dose of iron may be sufficient and also might prevent the complications of iron excess Previous studies have found that there is a correlation between mothers ' haemoglobin concentration or packed cell volume and infants ' birth weight , and that iron supplementation increases mothers ' haemoglobin concentration . The purpose of this study , using the data of a large r and omised trial on iron prophylaxis during pregnancy , was to find out whether iron supplementation causes fetal growth to deteriorate . At their first antenatal visit , 2912 pregnant women were r and omised into non-routine iron and routine iron supplementation . The mean length of gestation was shorter in the non-routine group . Birth weight did not differ between the groups , but due to longer gestations boys in the group receiving routine iron were taller than in the non-routine group . In both groups , whether studied by various values of packed cell volume or correlation coefficients , the lower the packed cell volume , the heavier and taller the infant and heavier the placenta . These negative correlations could be seen even with a packed cell volume measured early in pregnancy . St and ardising for blood pressure did not influence the correlation coefficients . The correlation between a high ratio for packed cell volume and poor fetal growth thus may not be caused by iron supplementation , nor mediated by blood pressure , but by some other mechanism OBJECTIVE : To determine the impact of iron deficiency anemia ( IDA ) in pregnancy on young child development . METHODS : A 2-year follow-up of 850 children born to women who participated in a double-blind cluster r and omized controlled trial of prenatal micronutrient supplementation in western rural China . These women were r and omly assigned to receive either daily folic acid , iron/folic acid ( 60 mg iron ) , or multiple micronutrients ( with 30 mg iron ) during pregnancy . Children were categorized into the prenatal-IDA and prenatal – non-IDA groups based on the mother ’s hemoglobin in the third trimester . Each group contained 3 subgroups based on mother ’s treatment : folic acid , iron/folic acid , and multiple micronutrients .  Bayley scales of infant development were administered to the children to assess their development at 3 , 6 , 12 , 18 , and 24 months of age . RESULTS : Compared with the prenatal – non-IDA group , the prenatal-IDA group showed a significantly lower mental development index at 12 , 18 , and 24 months of age . The adjusted mean difference was 5.8 ( 95 % confidence interval [ CI ] , 1.1–10.5 ) , 5.1 ( 95 % CI , 1.2–9.0 ) , and 5.3 ( 95 % CI , 0.9–9.7 ) , respectively . Further analysis showed that the mental development indexes in the prenatal-IDA group and prenatal – non-IDA group were similar with supplementation of iron/folic acid but were significantly lower in the prenatal-IDA group with supplementation of folic acid or multiple micronutrients . CONCLUSIONS : Prenatal IDA in the third trimester is associated with mental development of the child . However , prenatal supplementation with sufficient iron protects child development even when the woman ’s IDA was not properly corrected in pregnancy Background Gastrointestinal irritability can deter pregnant women from starting or continuing prenatal multivitamin supplementation . In a previous study , suboptimal tolerability was observed among pregnant women taking a large tablet ( 18 mm × 8 mm × 8 mm ) multivitamin with high elemental iron content ( 60 mg as ferrous fumarate ) . The objective of the present study was to compare rates of adherence and reported adverse events among pregnant women who were r and omized to commence supplementation with a small-tablet prenatal multivitamin , containing either low or high iron content . Methods Pregnant women who called the Motherisk Program ( Hospital for Sick Children , Toronto ) and had not started taking or had discontinued any multivitamin due to adverse events were included in this prospect i ve , r and omized , open-label , 2-arm study . Women were r and omized to take a small-size ( 16 mm × 9 mm × 4 mm ) , low elemental iron content ( 35 mg as ferrous fumarate ) multivitamin ( ' 35 mg ' group ) ; or a small-size ( 5 mm radius , 5 mm thickness ) , high elemental iron content ( 60 mg as ferrous sulphate ) multivitamin ( ' 60 mg ' group ) . Follow-up interviews documented pill intake and adverse events . Rates of adherence and adverse events were compared between groups using chi-squared tests and Kaplan-Meier survival curves . Results Of 167 r and omized women , 92 in the ' 35 mg ' group and 75 in the ' 60 mg ' group were included in the analysis . Despite ideal conditions and regular follow-ups , mean adherence based on pill intake recall , in both groups was approximately 50 % . No statistically significant difference was detected in proportions of women who actually started taking either multivitamin . Among those who started , no difference was detected in rates of adherence or reported adverse events . Conclusion The present results suggest that iron content is not a major determinant of adherence to prenatal multivitamins . Combined with our previous study , tablet size may be the more definitive factor affecting adherence Two hundred Hausa primigravidae at Zaria were divided into five groups in a r and omized double-blind trial of antenatal oral antimalarial prophylaxis , and haematinic supplements . Group 1 received no active treatment . Groups 2 to 5 were given chloroquine 600 mg base once , followed by proguanil 100 mg per day . In addition , group 3 received iron 60 mg daily , group 4 folic acid 1 mg daily , and group 5 iron plus folic acid .  Forty-five percent were anaemic ( haemoglobin ( Hb ) less than 11.0 g dl-1 ) at first attendance before 24 weeks of gestation , and malaria parasitaemia ( predominantly Plasmodium falciparum ) was seen in 27 % , of whom 60 % were anaemic . The mean Hb fell during pregnancy in group 1 , and seven patients in this group had to be removed from the trial and treated for severe anaemia ( packed cell volume ( PCV ) less than 0.26 ) . Only five patients in the other groups developed severe anaemia ( P = 0.006 ) , two of whom had malaria following failure to take treatment . Patients in group 1 had the lowest mean Hb at 28 and 36 weeks of gestation , and patients receiving antimalarials and iron ( groups 3 and 5 ) had the highest Hb at 28 weeks , but differences were not significant , possibly due to removal from the trial of patients with severe anaemia . Anaemia ( Hb less than 12.0 g dl-1 ) at six weeks after delivery was observed in 61 % of those not receiving active treatment ( group 1 ) , in 39 % of those protected against malaria but not receiving iron supplements ( groups 2 and 4 ) and in only 18 % of patients receiving both antimalarials and iron ( groups 3 and 5 ) . Folic acid had no significant effect on mean Hb .  Proguanil was confirmed to be a highly effective causal prophylaxis . Prevention of malaria , without folic acid supplements , reduced the frequency of megaloblastic erythropoiesis from 56 % to 25 % . Folic acid supplements abolished megaloblastosis , except in three patients who were apparently not taking the treatment prescribed . Red cell folate ( RCF ) concentrations were higher in subjects with malaria , probably due to intracellular synthesis by plasmodia . Infants of mothers not receiving antimalarials appeared to have an erythroid hyperplasia . Maternal folate supplements raised infants ' serum folate and RCF .  Fourteen per cent had low birth weight ( less than 2500 g ) , and the perinatal death rate was 11 % ; the greatest number were in group 1 , but not significantly . A regime is proposed for the prevention of malaria , iron deficiency , folate deficiency and anaemia in pregnancy in the guinea savanna of Nigeria Background Prenatal micronutrient combinations with high iron content are associated with high rates of gastrointestinal symptoms . This coupled with nausea and vomiting of pregnancy results in women often discontinuing their multivitamins . A new prescription supplement ( PregVit ® ) that separates iron from calcium in two tablets – morning and evening , has lower elemental iron content ( 35 mg ) , but results in similar extent of iron absorption when compared to another supplement containing ( 60 mg ) of elemental iron ( Materna ® ) . The objectives of this study were to compare tolerability and compliance with PregVit ® vs. a supplement with high iron content ( Materna ® ) , in pregnant women . Methods R and omized , crossover open labeled study in 135 pregnant women attending outpatient clinics in Ontario and Quebec . Results Use of PregVit ® was associated with a 30 % reduction in constipation rate as compared to Materna ® . Both products demonstrated similar compliance rates . Compliance of Materna ® was negatively associated with the severity of nausea and vomiting of pregnancy . No such correlation was found for PregVvit ® . Conclusion PregVit ® , a supplement with lower iron content ( 35 mg ) , has significantly decreased constipation rates as compared to 60 mg iron- Materna and has similar compliance rates . High iron content in multivitamin supplements is associated with adverse effects in pregnancy Iron absorption from four prenatal multivitamin/multimineral preparations was compared in 36 healthy pregnant women in their second or third trimester of pregnancy . The products studied were the currently marketed formulations of Stuartnatal 1 + 1 , Stuart Prenatal , Materna , and Natalins Rx . Each fasted subject received each of the four preparations , according to a r and omized sequence , at intervals of three to seven days between drug administrations . Stuartnatal 1 + 1 demonstrated the best iron absorption . Total iron absorbed from Stuartnatal 1 + 1 and Stuart Prenatal was well above the additional daily 3.5 mg recommended during pregnancy . Following administration of Materna the amount of iron was only slightly above that recommended , and following Natalins Rx it was well below . All formulations were generally well tolerated by the subjects Background The purpose of this study was compare of daily iron supplementation in three time frames- daily , weekly and three time weekly supplementation in preventing anemia in healthy pregnant women . Method The present study was a prospect i ve simply r and omized clinical trial . During January 2006- January 2008 , 150 healthy pregnant women without anemia , in their 16th week of pregnancy were r and omly allocated into three equal groups . The first group ( n = 50 ) received a 50 mg-ferrous sulfate tablet daily , second group ( n = 50 ) received a 50 mg-ferrous sulfate tablet three times a week , and the third group ( n = 50 ) received two 50 mg-ferrous sulfate tablets ( 100 mg ) weekly , respectively for 12 consecutive weeks . Serum hemoglobin , ferritin , and iron were measured before and after the supplementation . Paired t and ANOVA tests were used as appropriated . Results There were no significant differences between the pre- and post-treatment hemoglobin levels with iron supplementation in the three group ( P = 0.518 , P = 0.276 , respectively ) . The mean serum iron level before and after treatment with iron supplementation in the three groups was not statistically significant ( P = 0.962 , P = 0.970 , respectively ) . Although the mean serum ferritin level before and after treatment with iron supplementation was statistically significant in the three groups , no significant differences were found comparing the three groups ( P = 0.827 , P = 0.635 respectively ) . Conclusions This results suggested , three times a week or weekly iron supplementation is as effective as daily supplementation for healthy pregnant women without anemia . Trial Registration IS RCT N : I RCT OBJECTIVE To evaluate whether levels of iron status markers ( haemoglobin , serum transferrin saturation , serum ferritin ) in pregnant women , measured in the beginning of the second trimester , could be used to predict levels later in pregnancy , pre partum and post partum . DESIGN R and omized , double-blind , placebo-controlled parallel study . SETTING The Birth Clinic at the Department of Obstetrics , Herning Hospital , Herning , Denmark . SUBJECTS One hundred and twenty healthy pregnant women between 14 and 18 weeks of gestation . INTERVENTIONS Sixty-three women were allocated to treatment with tablets containing 66 mg ferrous iron ( as fumarate ) daily , and 57 women to treatment with placebo . MAIN OUTCOME MEASURES Haemoglobin , serum transfer 
    Output:
    