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: OBJECTIVE To pilot , among women with gestational diabetes mellitus ( GDM ) , the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program . The intervention was delivered by telephone , and support for breastfeeding was addressed . RESEARCH DESIGN AND METHODS The goal was to help women return to their prepregnancy weight , if it was normal , or achieve a 5 % reduction from prepregnancy weight if overweight . Eligible participants were identified shortly after a GDM diagnosis ; 83.8 % consented to be r and omly assigned to intervention or usual medical care ( 96 and 101 women , respectively ) . The retention was 85.2 % at 12 months postpartum . RESULTS The proportion of women who reached the postpartum weight goal was higher , although not statistically significant , in the intervention condition than among usual care ( 37.5 vs. 21.4 % , absolute difference 16.1 % , P = 0.07 ) . The intervention was more effective among women who did not exceed the recommended gestational weight gain ( difference in the proportion of women meeting the weight goals : 22.5 % , P = 0.04 ) . The intervention condition decreased dietary fat intake more than the usual care ( condition difference in the mean change in percent of calories from fat : −3.6 % , P = 0.002 ) and increased breastfeeding , although not significantly ( condition difference in proportion : 15.0 % , P = 0.09 ) . No differences in postpartum physical activity were observed between conditions . CONCLUSIONS This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight . Strategies to help postpartum women overcome barriers to increasing physical activity are needed OBJECTIVE : To investigate the effect of a supervised home-based exercise program on the recurrence and severity of gestational diabetes mellitus ( GDM )  together with other aspects of maternal health and obstetric and neonatal outcomes . METHODS : This r and omized controlled trial allocated women with a history of GDM to an  exercise intervention ( 14-week supervised home-based stationary cycling program ) or to a control group ( st and ard care ) at 13±1 weeks of gestation . The primary outcome was a diagnosis of GDM . Secondary outcomes included maternal fitness , psychological well-being , and obstetric and neonatal outcomes . A sample size of 180 ( 90 in each group ) was required to attain 80 % power to detect a 40 % reduction in the incidence of GDM . RESULTS : Between June 2011 and July 2014 , 205 women provided written consent and completed baseline assessment s. Of these , 33 ( 16 % ) were subsequently excluded as a result of an elevated baseline oral glucose tolerance test ( OGTT ) , leaving 172 r and omized to exercise ( n=85 ) or control ( n=87 ) . Three women miscarried before the assessment of outcome measures ( control=2 ; exercise=1 ) . All remaining women completed the postintervention OGTT . The recurrence rate of GDM was similar between groups ( control 40 % [ n=34 ] ; exercise 40.5 % [ n=34 ] ; P=.95 ) and the severity of GDM at diagnosis was unaffected by the exercise program with similar glucose and insulin responses to the OGTT ( glucose 2 hours post-OGTT 7.7±1.5 compared with 7.6±1.6 mmol/L ; P>.05 ) . Maternal fitness was improved by the exercise program ( P<.01 ) and psychological distress was reduced ( P=.02 ) . There were no differences in obstetric and neonatal outcomes between groups ( P>.05 ) . CONCLUSION : Supervised home-based exercise started at 14 weeks of gestation did not prevent the recurrence of GDM ; however , it was associated with important benefits for maternal fitness and psychological well-being . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , https:// clinical trials.gov , NCT01283854 To identify adherence required to achieve target health outcome ( s ) in nutrition and /or exercise interventions , a measurement tool that tracks objective and self-reported measures of adherence is necessary . The purpose of this study was to design an adherence measurement tool and test it retrospectively on the  Nutrition and Exercise Lifestyle Intervention Program  ( NELIP ; Ruchat et al. , Medicine and Science in Sports and Exercise , 44(8 ) , 1419–1426 , 2012 ; Mottola et al. , Medicine and Science in Sports and Exercise , 42(2 ) , 265–272 , 2010 ) , design ed to prevent excessive gestational weight gain ( EGWG ) . The tool was based on the goals of the NELIP and included a grading system for each behavior ( exercise and nutrition ) . It was used to determine whether adherence scores could differentiate excessive versus acceptable weight gain during pregnancy across pre-pregnancy body mass index ( BMI ) categories . Results showed irrespective of pre-pregnancy BMI , women with acceptable weight gain had significantly higher adherence ( p < 0.05 ) than women with excessive weight gain . It is recommended that this adherence tool be included in future prospect i ve lifestyle intervention studies 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 PURPOSE The purpose of the study was to determine the effect of a home-based cycling program for women with a recent diagnosis of gestational diabetes mellitus ( GDM ) on aerobic fitness , weight gain , self-reported mobility , attitude , and intentions toward maternal exercise , and obstetric and neonatal outcomes . METHODS Forty women ( mean ± SD , 28.8 ± 0.9-wk gestation ) were r and omized to either a supervised , home-based exercise program , combining continuous steady-state and interval cycling at various intensities , in combination with unsupervised moderate intensity aerobic activity and conventional diabetic management ( EX ; n = 20 ) or to conventional management alone ( CON ; n = 20 ) . The program began following diagnosis until week 34 of pregnancy ( mean ± SD duration of training , 6 ± 1 wk ) . RESULTS Mean compliance to the training program was 96 % . Maternal aerobic fitness , and attitude and intentions toward exercise were improved in response to the home-based exercise intervention compared with CON ( P < 0.05 ) . No differences were observed between the groups with respect to maternal weight gain or obstetric and neonatal outcomes ( P > 0.05 ) . CONCLUSION A home-based exercise program of 6 ± 1 wk in duration commenced after diagnosis of GDM can improve aerobic fitness and attitude and intentions toward exercise , with no adverse effect on maternal and neonatal pregnancy outcomes INTRODUCTION Walking may be a strategy for increasing moderate-intensity physical activity ( MPA )  during pregnancy . PURPOSE This study aim ed to promote MPA among overweight and obese pregnant women , via walking , and to evaluate the effect of the intervention on maternal and birth outcomes . METHODS Thirty-seven overweight or obese pregnant women were r and omly assigned to a walking intervention or control group . Anthropometric and objective PA ( StepWatch ™ Activity Monitor ) data were collected for four 1-wk periods : weeks 10 - 14 ( V1 ) , weeks 17 - 19 ( V2 ) , weeks 27 - 29 ( V3 ) , and weeks 34 - 36 ( V4 ) of gestation . Participants provided information about maternal and birth outcomes . A cadence of ≥ 80 steps per minute was defined as MPA , and " meaningful walking " was defined as moderate walking in ≥ 8-min bouts . ANOVA was used to determine the differences in walking amount and meaningful walks , the Kolmogorov-Smirnov test was used for walking intensity distribution analysis , and Fisher 's exact test was used for maternal and infant outcomes analyses . Pearson correlation was used to examine the association between prepregnancy body mass index and gestational weight gain ( GWG ) . RESULTS There was significantly more MPA among women in the intervention group compared with those in the control group at V2 ( overweight , P < 0.0001 ; obese , P < 0.025 ) , V3 ( overweight , P < 0.0001 ) , and V4 ( overweight , P < 0.0001 ; obese , P < 0.025 ) . Women in the intervention group significantly increased their meaningful walks at V2 ( P = 0.054 ) , V3 ( P = 0.01 ) , and V4 ( P = 0.014 ) . There were trends for intervention group women to have more favorable maternal and birth outcomes compared with the control group . Rates of GWG at measurement points during pregnancy were significantly associated with preceding rates of GWG . CONCLUSION The pilot , unsupervised walking intervention increased the MPA of overweight and obese women during pregnancy Background Previous publications indicate that acupuncture is efficient for the treatment of pelvic girdle pain , PGP , in pregnant women . However , the use of acupuncture for PGP is rare due to insufficient documentation of adverse effects of this treatment in this specific condition . The aim of the present work was to assess adverse effects of acupuncture on the pregnancy , mother , delivery and the fetus/neonate in comparison with women that received stabilising exercises as adjunct to st and ard treatment or st and ard treatment alone . Methods In all , 386 women with PGP entered this controlled , single-blind trial . They were r and omly assigned to st and ard treatment plus acupuncture ( n = 125 ) , st and ard treatment plus specific stabilising exercises ( n = 131 ) or to st and ard treatment alone ( n = 130 ) for 6 weeks . Acupuncture that may be considered strong was used and treatment was started as early as in the second trimester of pregnancy . Adverse effects were recorded during treatment and throughout the pregnancy . Influence on the fetus was measured with cardiotocography ( CTG ) before-during and after 43 acupuncture sessions in 43 women . A st and ardised computerized method to analyze the CTG reading numerically ( Oxford 8000 , Oxford , Engl and ) was used . After treatment , the women rated their overall experience of the treatment and listed adverse events if any in a question naire . Data of  analgesia and oxytocin augmentation during labour , duration of labour , frequency of preterm birth , operative delivery , Apgar score , cord-blood gas/acid base balance and birth weight were also recorded . Results There were no serious adverse events after any of the treatments . Minor adverse events were common in the acupuncture group but women rated acupuncture favourably even despite this . The computerized or visually assessed CTG analyses of antenatal recordings in connection with acupuncture were all normal . Conclusion This study shows that acupuncture administered with a stimulation that may be considered strong led to minor adverse complaints from the mothers but had no observable severe adverse influences on the pregnancy , mother , delivery or the fetus/neonate Context Lifestyle approaches for preventing gestational diabetes mellitus ( GDM ) have produced mixed results . Objective The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [ healthy eating ( HE ) , physical activity ( PA ) , and both HE and PA ( HE+PA ) ] with usual care ( UC ) in reducing GDM risk . Design The present study was a multicenter r and omized controlled trial conducted from 2012 to 2014 [ the DALI ( vitamin D and lifestyle intervention for GDM prevention ) lifestyle study ] . Setting The study occurred at antenatal clinics across 11 centers in 9 European countries . Patients Consecutive pregnant women at < 20 weeks of gestation with a body mass index ( BMI ) of ≥29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria ( n = 436 ) . For the intervention , women were r and omized , stratified by site , to UC , HE , PA , or HE+PA . The women received 5 face-to-face and ≤4 
    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: OBJECTIVE To pilot , among women with gestational diabetes mellitus ( GDM ) , the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program . The intervention was delivered by telephone , and support for breastfeeding was addressed . RESEARCH DESIGN AND METHODS The goal was to help women return to their prepregnancy weight , if it was normal , or achieve a 5 % reduction from prepregnancy weight if overweight . Eligible participants were identified shortly after a GDM diagnosis ; 83.8 % consented to be r and omly assigned to intervention or usual medical care ( 96 and 101 women , respectively ) . The retention was 85.2 % at 12 months postpartum . RESULTS The proportion of women who reached the postpartum weight goal was higher , although not statistically significant , in the intervention condition than among usual care ( 37.5 vs. 21.4 % , absolute difference 16.1 % , P = 0.07 ) . The intervention was more effective among women who did not exceed the recommended gestational weight gain ( difference in the proportion of women meeting the weight goals : 22.5 % , P = 0.04 ) . The intervention condition decreased dietary fat intake more than the usual care ( condition difference in the mean change in percent of calories from fat : −3.6 % , P = 0.002 ) and increased breastfeeding , although not significantly ( condition difference in proportion : 15.0 % , P = 0.09 ) . No differences in postpartum physical activity were observed between conditions . CONCLUSIONS This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight . Strategies to help postpartum women overcome barriers to increasing physical activity are needed OBJECTIVE : To investigate the effect of a supervised home-based exercise program on the recurrence and severity of gestational diabetes mellitus ( GDM )  together with other aspects of maternal health and obstetric and neonatal outcomes . METHODS : This r and omized controlled trial allocated women with a history of GDM to an  exercise intervention ( 14-week supervised home-based stationary cycling program ) or to a control group ( st and ard care ) at 13±1 weeks of gestation . The primary outcome was a diagnosis of GDM . Secondary outcomes included maternal fitness , psychological well-being , and obstetric and neonatal outcomes . A sample size of 180 ( 90 in each group ) was required to attain 80 % power to detect a 40 % reduction in the incidence of GDM . RESULTS : Between June 2011 and July 2014 , 205 women provided written consent and completed baseline assessment s. Of these , 33 ( 16 % ) were subsequently excluded as a result of an elevated baseline oral glucose tolerance test ( OGTT ) , leaving 172 r and omized to exercise ( n=85 ) or control ( n=87 ) . Three women miscarried before the assessment of outcome measures ( control=2 ; exercise=1 ) . All remaining women completed the postintervention OGTT . The recurrence rate of GDM was similar between groups ( control 40 % [ n=34 ] ; exercise 40.5 % [ n=34 ] ; P=.95 ) and the severity of GDM at diagnosis was unaffected by the exercise program with similar glucose and insulin responses to the OGTT ( glucose 2 hours post-OGTT 7.7±1.5 compared with 7.6±1.6 mmol/L ; P>.05 ) . Maternal fitness was improved by the exercise program ( P<.01 ) and psychological distress was reduced ( P=.02 ) . There were no differences in obstetric and neonatal outcomes between groups ( P>.05 ) . CONCLUSION : Supervised home-based exercise started at 14 weeks of gestation did not prevent the recurrence of GDM ; however , it was associated with important benefits for maternal fitness and psychological well-being . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , https:// clinical trials.gov , NCT01283854 To identify adherence required to achieve target health outcome ( s ) in nutrition and /or exercise interventions , a measurement tool that tracks objective and self-reported measures of adherence is necessary . The purpose of this study was to design an adherence measurement tool and test it retrospectively on the  Nutrition and Exercise Lifestyle Intervention Program  ( NELIP ; Ruchat et al. , Medicine and Science in Sports and Exercise , 44(8 ) , 1419–1426 , 2012 ; Mottola et al. , Medicine and Science in Sports and Exercise , 42(2 ) , 265–272 , 2010 ) , design ed to prevent excessive gestational weight gain ( EGWG ) . The tool was based on the goals of the NELIP and included a grading system for each behavior ( exercise and nutrition ) . It was used to determine whether adherence scores could differentiate excessive versus acceptable weight gain during pregnancy across pre-pregnancy body mass index ( BMI ) categories . Results showed irrespective of pre-pregnancy BMI , women with acceptable weight gain had significantly higher adherence ( p < 0.05 ) than women with excessive weight gain . It is recommended that this adherence tool be included in future prospect i ve lifestyle intervention studies 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 PURPOSE The purpose of the study was to determine the effect of a home-based cycling program for women with a recent diagnosis of gestational diabetes mellitus ( GDM ) on aerobic fitness , weight gain , self-reported mobility , attitude , and intentions toward maternal exercise , and obstetric and neonatal outcomes . METHODS Forty women ( mean ± SD , 28.8 ± 0.9-wk gestation ) were r and omized to either a supervised , home-based exercise program , combining continuous steady-state and interval cycling at various intensities , in combination with unsupervised moderate intensity aerobic activity and conventional diabetic management ( EX ; n = 20 ) or to conventional management alone ( CON ; n = 20 ) . The program began following diagnosis until week 34 of pregnancy ( mean ± SD duration of training , 6 ± 1 wk ) . RESULTS Mean compliance to the training program was 96 % . Maternal aerobic fitness , and attitude and intentions toward exercise were improved in response to the home-based exercise intervention compared with CON ( P < 0.05 ) . No differences were observed between the groups with respect to maternal weight gain or obstetric and neonatal outcomes ( P > 0.05 ) . CONCLUSION A home-based exercise program of 6 ± 1 wk in duration commenced after diagnosis of GDM can improve aerobic fitness and attitude and intentions toward exercise , with no adverse effect on maternal and neonatal pregnancy outcomes INTRODUCTION Walking may be a strategy for increasing moderate-intensity physical activity ( MPA )  during pregnancy . PURPOSE This study aim ed to promote MPA among overweight and obese pregnant women , via walking , and to evaluate the effect of the intervention on maternal and birth outcomes . METHODS Thirty-seven overweight or obese pregnant women were r and omly assigned to a walking intervention or control group . Anthropometric and objective PA ( StepWatch ™ Activity Monitor ) data were collected for four 1-wk periods : weeks 10 - 14 ( V1 ) , weeks 17 - 19 ( V2 ) , weeks 27 - 29 ( V3 ) , and weeks 34 - 36 ( V4 ) of gestation . Participants provided information about maternal and birth outcomes . A cadence of ≥ 80 steps per minute was defined as MPA , and " meaningful walking " was defined as moderate walking in ≥ 8-min bouts . ANOVA was used to determine the differences in walking amount and meaningful walks , the Kolmogorov-Smirnov test was used for walking intensity distribution analysis , and Fisher 's exact test was used for maternal and infant outcomes analyses . Pearson correlation was used to examine the association between prepregnancy body mass index and gestational weight gain ( GWG ) . RESULTS There was significantly more MPA among women in the intervention group compared with those in the control group at V2 ( overweight , P < 0.0001 ; obese , P < 0.025 ) , V3 ( overweight , P < 0.0001 ) , and V4 ( overweight , P < 0.0001 ; obese , P < 0.025 ) . Women in the intervention group significantly increased their meaningful walks at V2 ( P = 0.054 ) , V3 ( P = 0.01 ) , and V4 ( P = 0.014 ) . There were trends for intervention group women to have more favorable maternal and birth outcomes compared with the control group . Rates of GWG at measurement points during pregnancy were significantly associated with preceding rates of GWG . CONCLUSION The pilot , unsupervised walking intervention increased the MPA of overweight and obese women during pregnancy Background Previous publications indicate that acupuncture is efficient for the treatment of pelvic girdle pain , PGP , in pregnant women . However , the use of acupuncture for PGP is rare due to insufficient documentation of adverse effects of this treatment in this specific condition . The aim of the present work was to assess adverse effects of acupuncture on the pregnancy , mother , delivery and the fetus/neonate in comparison with women that received stabilising exercises as adjunct to st and ard treatment or st and ard treatment alone . Methods In all , 386 women with PGP entered this controlled , single-blind trial . They were r and omly assigned to st and ard treatment plus acupuncture ( n = 125 ) , st and ard treatment plus specific stabilising exercises ( n = 131 ) or to st and ard treatment alone ( n = 130 ) for 6 weeks . Acupuncture that may be considered strong was used and treatment was started as early as in the second trimester of pregnancy . Adverse effects were recorded during treatment and throughout the pregnancy . Influence on the fetus was measured with cardiotocography ( CTG ) before-during and after 43 acupuncture sessions in 43 women . A st and ardised computerized method to analyze the CTG reading numerically ( Oxford 8000 , Oxford , Engl and ) was used . After treatment , the women rated their overall experience of the treatment and listed adverse events if any in a question naire . Data of  analgesia and oxytocin augmentation during labour , duration of labour , frequency of preterm birth , operative delivery , Apgar score , cord-blood gas/acid base balance and birth weight were also recorded . Results There were no serious adverse events after any of the treatments . Minor adverse events were common in the acupuncture group but women rated acupuncture favourably even despite this . The computerized or visually assessed CTG analyses of antenatal recordings in connection with acupuncture were all normal . Conclusion This study shows that acupuncture administered with a stimulation that may be considered strong led to minor adverse complaints from the mothers but had no observable severe adverse influences on the pregnancy , mother , delivery or the fetus/neonate Context Lifestyle approaches for preventing gestational diabetes mellitus ( GDM ) have produced mixed results . Objective The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [ healthy eating ( HE ) , physical activity ( PA ) , and both HE and PA ( HE+PA ) ] with usual care ( UC ) in reducing GDM risk . Design The present study was a multicenter r and omized controlled trial conducted from 2012 to 2014 [ the DALI ( vitamin D and lifestyle intervention for GDM prevention ) lifestyle study ] . Setting The study occurred at antenatal clinics across 11 centers in 9 European countries . Patients Consecutive pregnant women at < 20 weeks of gestation with a body mass index ( BMI ) of ≥29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria ( n = 436 ) . For the intervention , women were r and omized , stratified by site , to UC , HE , PA , or HE+PA . The women received 5 face-to-face and ≤4 
    Output:
    