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 : Racial differences in chronic maternal stress may contribute to disparities in pregnancy outcomes . The objective is to identify racial and ethnic differences in self-reported and biologic measures of stress between non-Hispanic black ( NHB ) and non-Hispanic white ( NHW ) pregnant women . Study Design : NHB and NHW pregnant women were enrolled before 23 weeks of gestation in this prospect i ve cohort study . Equal numbers of women were recruited with public vs private insurance in each racial group .  Self-reported stress  was measured and blood sample s collected in the second and third trimesters were analyzed for serum Epstein – Barr virus antibody , C-reactive protein ( CRP ) , corticotropin-releasing hormone ( CRH ) and adenocorticotropic hormone ( ACTH ) . Results : One hundred and twelve women were enrolled . NHW women reported more buffers against stress ( P=0.04 ) and neighborhood satisfaction ( P=0.02 ) . NHB women reported more discrimination ( P<0.001 ) , food insecurity ( P=0.04 ) and had significantly higher mean CRP levels and mean ACTH levels in the second and third trimesters . Conclusion : Significant differences in self-reported and biologic measures of chronic stress were identified between NHB and NHW pregnant women with similar economic characteristics . Future studies should investigate mechanisms underlying these differences and their relationship to pregnancy outcomes RATIONALE Food insecurity has emerged as an important , and potentially modifiable , risk factor for  depression . Few studies have brought longitudinal data to bear on investigating this association in sub-Saharan Africa . OBJECTIVE To estimate the association between food insufficiency and depression symptom severity , and to determine the extent to which any observed associations were modified by social support . METHODS AND RESULTS We conducted a secondary analysis of population -based , longitudinal data collected from 1238 pregnant women during a three-year cluster-r and omized trial of a home visiting intervention in Cape Town , South Africa . Surveys were conducted at baseline , 6 months , 18 months , and 36 months ( 85 % retention ) . A vali date d , single-item food insufficiency measure inquired about the number of days of hunger in the past week . Depression symptom severity was measured using the Xhosa version of the 10-item Edinburgh Postnatal Depression Scale . In multivariable regression models with cluster-correlated robust estimates of variance , lagged food insufficiency had a strong and statistically significant association with depression symptom severity ( β = 0.70 ; 95 % CI , 0.46 - 0.94 ) , suggesting a 6.5 % relative difference in depression symptom severity per day of hunger . In stratified analyses , food insufficiency had a statistically significant association with depression only among women with low levels of instrumental support . Using quantile regression , we found that the adverse impacts of food insufficiency were experienced to a greater degree by women in the upper end of the conditional distribution of depression symptom severity . Estimates from fixed-effects regression models and fixed-effects quantile regression models , accounting for unobserved confounding by time-invariant characteristics , were similar . CONCLUSIONS Food insufficiency was associated with depression symptom severity , particularly for women in the upper end of the conditional depression distribution . Instrumental social support buffered women against the adverse impacts of food insufficiency We determined factors associated with diet quality and assessed the relationship between diet quality , birth weight , and gestational age in a prospect i ve national multicenter cohort study . We evaluated diet quality with the Healthy Eating Index ( HEI , scale 0 - 100 ) in the third trimester of pregnancy with three 24-hr multiple-pass dietary recalls in 266 HIV+ women enrolled in the Pediatric HIV/AIDS Cohort Study . Covariates included demographics , food security , pre-pregnancy body mass index , HIV disease severity , substance use , and antiretroviral exposures . A two-stage multivariate process using classification and regression trees ( CART ) followed by multiple regression described HEI tendencies , controlled possible confounding effects , and examined the association of HEI with birth weight and gestational age . To assess the stability of the CART solution , both the HEI 2005 and 2010 were evaluated . The mean HEI scores were 56.1 and 47.5 for the 2005 and 2010 HEI , respectively . The first-stage CART analysis examined the relationship between HEI and covariates . Non-US born versus US-born mothers had higher HEI scores ( 15-point difference , R2 = 0.28 ) . There was a secondary partition due to alcohol/cigarette/illicit drug usage ( 3.5-point difference , R2 = 0.03 ) among US-born women . For the second-stage CART adjusted multiple regression , birth weight z-score was positively related to HEI 2005 and 2010 ( partial r 's > 0.13 , P 's ≤ 0.0398 ) , but not gestational age ( r = 0.00 ) . We conclude that diet quality among HIV+ women is associated with higher birth weight . Despite the influence of a large cultural effect and poor prenatal behaviors , interventions to improve diet  in HIV+ women may help to increase birth weight Household food insecurity has been associated with several negative health outcomes , yet little is known about the prevalence and correlates of household food insecurity during pregnancy . This study was conducted as part of the Pregnancy , Infection , and Nutrition prospect i ve cohort study to identify risk factors of preterm birth . The USDA 18-item scale was used to assess the prevalence of food insecurity among pregnant women with incomes < or= 400 % of poverty . Descriptive statistics and logistic regression were used to identify socioeconomic , demographic , and psychosocial predictors of household food insecurity . Among 606 pregnant women , 75 % were from fully food-secure , 15 % from marginally food-secure , and 10 % from food-insecure households . Women from marginally food-secure and food-insecure households had significantly less income , less education , and were older than women from fully food-secure households . In bivariate analysis , all psychosocial factors were significantly associated with household food insecurity and showed a dose-response relation with increasing food insecurity . Socioeconomic and demographic predictors for household food insecurity were income , black race , and age . After controlling for socioeconomic and demographic variables , psychosocial indicators of perceived stress , trait anxiety , and depressive symptoms , and a locus of control attributed to chance were positively associated with any household food insecurity . Conversely , self-esteem and mastery were inversely associated with any household food insecurity . Psychosocial factors as well as socioeconomic and demographic indicators are associated with household food insecurity among pregnant women ; however , the direction of causation between psychosocial indicators and food insecurity can not be determined in these data Background Several studies witnessed that prenatal zinc deficiency ( ZD ) predisposes to diverse pregnancy complications . However , scientific evidence s on the determinants of prenatal ZD are scanty and inconclusive . The purpose of the present study was to assess the prevalence and determinants of prenatal ZD in Sidama zone , Southern Ethiopia . Methods A community based , cross-sectional study was conducted in Sidama zone in January and February 2011 . R and omly selected 700 pregnant women were included in the study . Data on potential determinants of ZD were gathered using a structured question naire . Serum zinc concentration  was measured using Atomic Absorption Spectrometry . Statistical analysis was done using logistic regression and linear regression . Results The mean serum zinc concentration was 52.4 ( + /-9.9 ) μg/dl ( 95 % CI : 51.6 - 53.1 μg/dl ) . About 53.0 % ( 95 % CI : 49.3 - 56.7 % ) of the subjects were zinc deficient . The majority of the explained variability of serum zinc was due to dietary factors like household food insecurity level , dietary diversity and consumption of animal source foods . The risk of ZD was 1.65 ( 95 % CI : 1.02 - 2.67 ) times higher among women from maize staple diet category compared to  Enset staple diet category . Compared to pregnant women aged 15 - 24 years , those aged 25 - 34 and 35 - 49 years had 1.57 ( 95 % CI : 1.04 - 2.34 ) and 2.18 ( 95 % CI : 1.25 - 3.63 ) times higher risk of ZD , respectively . Women devoid of self income had 1.74 ( 95 % CI : 1.11 - 2.74 ) time increased risk than their counterparts . Maternal education was positively associated to zinc status . Gr and multiparas were 1.74 ( 95 % CI : 1.09 - 3.23 ) times more likely to be zinc deficient than nulliparas . Frequency of coffee intake was negatively association to serum zinc level . Positive association was noted between serum zinc and hemoglobin concentrations . Altitude , history of iron supplementation , maternal workload , physical access to health service , antenatal care and nutrition education were not associated to zinc status . Conclusion ZD is of public health concern in the area . The problem must be combated through a combination of short , medium and long-term strategies . This includes the use of household based phytate reduction food processing techniques , agricultural based approaches and livelihood promotion strategies Background This study investigated the prevalence and socio-cultural correlates of postnatal mood disturbance amongst women 18–45 years old in Central Vietnam . Son preference and traditional confinement practice s were explored as well as factors such as poverty , parity , family and intimate partner relationships and infant health . Methods A cross-sectional study was conducted in twelve r and omly selected Commune Health Centres from urban and rural districts of Thua Thien Hue Province , Vietnam . Mother-infant dyads one to six months postpartum were invited to participate . Question naires from 431 mothers ( urban n = 216 ; rural n = 215 ) assessed demographic and family characteristics , traditional confinement practice s , son preference , infant health and social capital . The Edinburgh Postnatal Depression Scale ( EPDS ) and WHO5 Wellbeing Index indicated depressive symptoms and emotional wellbeing . Data were analysed using general linear models . Results Using an EPDS cut-off of 12/13 , 18.1 % ( n = 78 , 95 % CI 14.6 - 22.1 ) of women had depressive symptoms ( 20.4 % urban ; 15.8 % rural ) . Contrary to predictions , infant gender and traditional confinement were unrelated to depressive symptoms . Poverty , food insecurity , being frightened of family members , and intimate partner violence increased both depressive symptoms and lowered wellbeing . The first model accounted for 30.2 % of the variance in EPDS score and found being frightened of one ’s husb and , husb and ’s unemployment , breastfeeding difficulties , infant diarrhoea , and cognitive social capital were associated with higher EPDS scores . The second model had accounted for 22 % of the variance in WHO5 score . Living in Hue city , low education , poor maternal competence and a negative family response to the baby lowered maternal wellbeing . Conclusions Traditional confinement practice s and son preference were not linked to depressive symptoms among mothers , but were correlates of family relationships and wellbeing . Poverty , food insecurity , violence , infant ill health , and discordant intimate and family relationships were linked with depressive symptoms in Central Vietnam BACKGROUND Household food insecurity is positively associated with weight among women . The association between household food insecurity and pregnancy-related  weight gain and complications is not well understood . OBJECTIVE To identify whether an independent association exists between household food insecurity and pregnancy-related complications . DESIGN Data from the Pregnancy , Infection , and Nutrition prospect i ve cohort study were used to assess household food insecurity retrospectively using the US Department of Agriculture 18-item Core Food Security Module among 810 pregnant women with incomes < or = 400 % of the income/poverty ratio , recruited between January 2001 and June 2005 and followed through pregnancy . MAIN OUTCOME MEASURES Self-reported pregravid body mass index , gestational weight gain , second trimester anemia , pregnancy-induced hypertension , and gestational diabetes mellitus . STATISTICAL ANALYSES PERFORMED Multivariate linear , multinomial logistic , and logistic regression analyses . RESULTS Among 810 pregnant women , 76 % were from fully food secure , 14 % were from marginally food secure , and 10 % were from food insecure households . In adjusted models , living in a food insecure household was significantly associated with severe pregravid obesity ( adjusted odds ratio 2.97 , 95 % confidence intervals [ CIs ] 1.44 to 6.14 ) , higher gestational weight gain ( adjusted beta coefficient 1.87 , 95 % CI 0.13 to 3.62 ) , and with a higher adequacy of weight gain ratio ( adjusted beta .27 , 95 % CI 0.07 to 0.50 ) . Marginal food security was significantly associated with gestational diabetes mellitus ( adjusted odds ratio 2.76 , 95 % CI 1.00 to 7.66 ) . CONCLUSIONS This study highlights the possibility that living in a food insecure household during pregnancy may increase risk of greater weight gain 
    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 : Racial differences in chronic maternal stress may contribute to disparities in pregnancy outcomes . The objective is to identify racial and ethnic differences in self-reported and biologic measures of stress between non-Hispanic black ( NHB ) and non-Hispanic white ( NHW ) pregnant women . Study Design : NHB and NHW pregnant women were enrolled before 23 weeks of gestation in this prospect i ve cohort study . Equal numbers of women were recruited with public vs private insurance in each racial group .  Self-reported stress  was measured and blood sample s collected in the second and third trimesters were analyzed for serum Epstein – Barr virus antibody , C-reactive protein ( CRP ) , corticotropin-releasing hormone ( CRH ) and adenocorticotropic hormone ( ACTH ) . Results : One hundred and twelve women were enrolled . NHW women reported more buffers against stress ( P=0.04 ) and neighborhood satisfaction ( P=0.02 ) . NHB women reported more discrimination ( P<0.001 ) , food insecurity ( P=0.04 ) and had significantly higher mean CRP levels and mean ACTH levels in the second and third trimesters . Conclusion : Significant differences in self-reported and biologic measures of chronic stress were identified between NHB and NHW pregnant women with similar economic characteristics . Future studies should investigate mechanisms underlying these differences and their relationship to pregnancy outcomes RATIONALE Food insecurity has emerged as an important , and potentially modifiable , risk factor for  depression . Few studies have brought longitudinal data to bear on investigating this association in sub-Saharan Africa . OBJECTIVE To estimate the association between food insufficiency and depression symptom severity , and to determine the extent to which any observed associations were modified by social support . METHODS AND RESULTS We conducted a secondary analysis of population -based , longitudinal data collected from 1238 pregnant women during a three-year cluster-r and omized trial of a home visiting intervention in Cape Town , South Africa . Surveys were conducted at baseline , 6 months , 18 months , and 36 months ( 85 % retention ) . A vali date d , single-item food insufficiency measure inquired about the number of days of hunger in the past week . Depression symptom severity was measured using the Xhosa version of the 10-item Edinburgh Postnatal Depression Scale . In multivariable regression models with cluster-correlated robust estimates of variance , lagged food insufficiency had a strong and statistically significant association with depression symptom severity ( β = 0.70 ; 95 % CI , 0.46 - 0.94 ) , suggesting a 6.5 % relative difference in depression symptom severity per day of hunger . In stratified analyses , food insufficiency had a statistically significant association with depression only among women with low levels of instrumental support . Using quantile regression , we found that the adverse impacts of food insufficiency were experienced to a greater degree by women in the upper end of the conditional distribution of depression symptom severity . Estimates from fixed-effects regression models and fixed-effects quantile regression models , accounting for unobserved confounding by time-invariant characteristics , were similar . CONCLUSIONS Food insufficiency was associated with depression symptom severity , particularly for women in the upper end of the conditional depression distribution . Instrumental social support buffered women against the adverse impacts of food insufficiency We determined factors associated with diet quality and assessed the relationship between diet quality , birth weight , and gestational age in a prospect i ve national multicenter cohort study . We evaluated diet quality with the Healthy Eating Index ( HEI , scale 0 - 100 ) in the third trimester of pregnancy with three 24-hr multiple-pass dietary recalls in 266 HIV+ women enrolled in the Pediatric HIV/AIDS Cohort Study . Covariates included demographics , food security , pre-pregnancy body mass index , HIV disease severity , substance use , and antiretroviral exposures . A two-stage multivariate process using classification and regression trees ( CART ) followed by multiple regression described HEI tendencies , controlled possible confounding effects , and examined the association of HEI with birth weight and gestational age . To assess the stability of the CART solution , both the HEI 2005 and 2010 were evaluated . The mean HEI scores were 56.1 and 47.5 for the 2005 and 2010 HEI , respectively . The first-stage CART analysis examined the relationship between HEI and covariates . Non-US born versus US-born mothers had higher HEI scores ( 15-point difference , R2 = 0.28 ) . There was a secondary partition due to alcohol/cigarette/illicit drug usage ( 3.5-point difference , R2 = 0.03 ) among US-born women . For the second-stage CART adjusted multiple regression , birth weight z-score was positively related to HEI 2005 and 2010 ( partial r 's > 0.13 , P 's ≤ 0.0398 ) , but not gestational age ( r = 0.00 ) . We conclude that diet quality among HIV+ women is associated with higher birth weight . Despite the influence of a large cultural effect and poor prenatal behaviors , interventions to improve diet  in HIV+ women may help to increase birth weight Household food insecurity has been associated with several negative health outcomes , yet little is known about the prevalence and correlates of household food insecurity during pregnancy . This study was conducted as part of the Pregnancy , Infection , and Nutrition prospect i ve cohort study to identify risk factors of preterm birth . The USDA 18-item scale was used to assess the prevalence of food insecurity among pregnant women with incomes < or= 400 % of poverty . Descriptive statistics and logistic regression were used to identify socioeconomic , demographic , and psychosocial predictors of household food insecurity . Among 606 pregnant women , 75 % were from fully food-secure , 15 % from marginally food-secure , and 10 % from food-insecure households . Women from marginally food-secure and food-insecure households had significantly less income , less education , and were older than women from fully food-secure households . In bivariate analysis , all psychosocial factors were significantly associated with household food insecurity and showed a dose-response relation with increasing food insecurity . Socioeconomic and demographic predictors for household food insecurity were income , black race , and age . After controlling for socioeconomic and demographic variables , psychosocial indicators of perceived stress , trait anxiety , and depressive symptoms , and a locus of control attributed to chance were positively associated with any household food insecurity . Conversely , self-esteem and mastery were inversely associated with any household food insecurity . Psychosocial factors as well as socioeconomic and demographic indicators are associated with household food insecurity among pregnant women ; however , the direction of causation between psychosocial indicators and food insecurity can not be determined in these data Background Several studies witnessed that prenatal zinc deficiency ( ZD ) predisposes to diverse pregnancy complications . However , scientific evidence s on the determinants of prenatal ZD are scanty and inconclusive . The purpose of the present study was to assess the prevalence and determinants of prenatal ZD in Sidama zone , Southern Ethiopia . Methods A community based , cross-sectional study was conducted in Sidama zone in January and February 2011 . R and omly selected 700 pregnant women were included in the study . Data on potential determinants of ZD were gathered using a structured question naire . Serum zinc concentration  was measured using Atomic Absorption Spectrometry . Statistical analysis was done using logistic regression and linear regression . Results The mean serum zinc concentration was 52.4 ( + /-9.9 ) μg/dl ( 95 % CI : 51.6 - 53.1 μg/dl ) . About 53.0 % ( 95 % CI : 49.3 - 56.7 % ) of the subjects were zinc deficient . The majority of the explained variability of serum zinc was due to dietary factors like household food insecurity level , dietary diversity and consumption of animal source foods . The risk of ZD was 1.65 ( 95 % CI : 1.02 - 2.67 ) times higher among women from maize staple diet category compared to  Enset staple diet category . Compared to pregnant women aged 15 - 24 years , those aged 25 - 34 and 35 - 49 years had 1.57 ( 95 % CI : 1.04 - 2.34 ) and 2.18 ( 95 % CI : 1.25 - 3.63 ) times higher risk of ZD , respectively . Women devoid of self income had 1.74 ( 95 % CI : 1.11 - 2.74 ) time increased risk than their counterparts . Maternal education was positively associated to zinc status . Gr and multiparas were 1.74 ( 95 % CI : 1.09 - 3.23 ) times more likely to be zinc deficient than nulliparas . Frequency of coffee intake was negatively association to serum zinc level . Positive association was noted between serum zinc and hemoglobin concentrations . Altitude , history of iron supplementation , maternal workload , physical access to health service , antenatal care and nutrition education were not associated to zinc status . Conclusion ZD is of public health concern in the area . The problem must be combated through a combination of short , medium and long-term strategies . This includes the use of household based phytate reduction food processing techniques , agricultural based approaches and livelihood promotion strategies Background This study investigated the prevalence and socio-cultural correlates of postnatal mood disturbance amongst women 18–45 years old in Central Vietnam . Son preference and traditional confinement practice s were explored as well as factors such as poverty , parity , family and intimate partner relationships and infant health . Methods A cross-sectional study was conducted in twelve r and omly selected Commune Health Centres from urban and rural districts of Thua Thien Hue Province , Vietnam . Mother-infant dyads one to six months postpartum were invited to participate . Question naires from 431 mothers ( urban n = 216 ; rural n = 215 ) assessed demographic and family characteristics , traditional confinement practice s , son preference , infant health and social capital . The Edinburgh Postnatal Depression Scale ( EPDS ) and WHO5 Wellbeing Index indicated depressive symptoms and emotional wellbeing . Data were analysed using general linear models . Results Using an EPDS cut-off of 12/13 , 18.1 % ( n = 78 , 95 % CI 14.6 - 22.1 ) of women had depressive symptoms ( 20.4 % urban ; 15.8 % rural ) . Contrary to predictions , infant gender and traditional confinement were unrelated to depressive symptoms . Poverty , food insecurity , being frightened of family members , and intimate partner violence increased both depressive symptoms and lowered wellbeing . The first model accounted for 30.2 % of the variance in EPDS score and found being frightened of one ’s husb and , husb and ’s unemployment , breastfeeding difficulties , infant diarrhoea , and cognitive social capital were associated with higher EPDS scores . The second model had accounted for 22 % of the variance in WHO5 score . Living in Hue city , low education , poor maternal competence and a negative family response to the baby lowered maternal wellbeing . Conclusions Traditional confinement practice s and son preference were not linked to depressive symptoms among mothers , but were correlates of family relationships and wellbeing . Poverty , food insecurity , violence , infant ill health , and discordant intimate and family relationships were linked with depressive symptoms in Central Vietnam BACKGROUND Household food insecurity is positively associated with weight among women . The association between household food insecurity and pregnancy-related  weight gain and complications is not well understood . OBJECTIVE To identify whether an independent association exists between household food insecurity and pregnancy-related complications . DESIGN Data from the Pregnancy , Infection , and Nutrition prospect i ve cohort study were used to assess household food insecurity retrospectively using the US Department of Agriculture 18-item Core Food Security Module among 810 pregnant women with incomes < or = 400 % of the income/poverty ratio , recruited between January 2001 and June 2005 and followed through pregnancy . MAIN OUTCOME MEASURES Self-reported pregravid body mass index , gestational weight gain , second trimester anemia , pregnancy-induced hypertension , and gestational diabetes mellitus . STATISTICAL ANALYSES PERFORMED Multivariate linear , multinomial logistic , and logistic regression analyses . RESULTS Among 810 pregnant women , 76 % were from fully food secure , 14 % were from marginally food secure , and 10 % were from food insecure households . In adjusted models , living in a food insecure household was significantly associated with severe pregravid obesity ( adjusted odds ratio 2.97 , 95 % confidence intervals [ CIs ] 1.44 to 6.14 ) , higher gestational weight gain ( adjusted beta coefficient 1.87 , 95 % CI 0.13 to 3.62 ) , and with a higher adequacy of weight gain ratio ( adjusted beta .27 , 95 % CI 0.07 to 0.50 ) . Marginal food security was significantly associated with gestational diabetes mellitus ( adjusted odds ratio 2.76 , 95 % CI 1.00 to 7.66 ) . CONCLUSIONS This study highlights the possibility that living in a food insecure household during pregnancy may increase risk of greater weight gain 
    Output:
    