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: Abstract Objective : To investigate the relations of maternal diet and smoking during pregnancy to placental and birth weights at term . Design : Prospect i ve cohort study . Setting : District general hospital in the south of Engl and . Participants : 693 pregnant nulliparous white women with singleton pregnancies who were selected from antenatal booking clinics with stratified r and om sampling . Main outcome measures : Birth and placental weights at term . Results : Placental and birth weights were unrelated to the intake of any macronutrient . Early in pregnancy , vitamin C was the only micronutrient independently associated with birth weight after adjustment for maternal height and smoking . Each ln mg increase in vitamin C was associated with a 50.8 g ( 95 % confidence interval 4.6 g to 97.0 g ) increase in birth weight . Vitamin C , vitamin E , and folate were each associated with placental weight after adjustment for maternal characteristics . In simultaneous regression , however , vitamin C was the only nutrient predictive of placental weight : each ln mg increase in vitamin C was associated with a 3.2 % ( 0.4 to 6.1 ) rise in placental weight . No nutrient late in pregnancy was associated with either placental or birth weight . Conclusions : Concern over the impact of maternal nutrition on the health of the infant has been premature Maternal nutrition , at least in industrialised population s , seems to have only a small effect on placental and birth weights . Other possible determinants of fetal and placental growth should be investigated . Key messages Placental and infant birth weights were not associated with the intake of any macronutrient early or later in pregnancy After adjustment for the effects of maternal height and smoking , only vitamin C independently predicted birth weight . The expected mean difference in birth weight for infants with mothers in the upper and lower thirds of intake was about 70 g Vitamin C was the only nutrient that independently predicted placental weight , but again this relation was of doubtful clinical significance Among relatively well nourished women in industrialised countries , maternal nutrition seems to have only a marginal impact on infant and placental size . Other causes of variation in the size of clinical ly normal infants should now be Objective To determine whether antioxidant therapy alters the disease process in severe early onset pre‐eclampsia , in support of the hypothesis that increased lipid peroxides and reactive oxygen species production play an important role in the pathogenesis of the disease OBJECTIVE To assess the relationship between glycemic control , pre-eclampsia , and gestational hypertension in women with type 1 diabetes . RESEARCH DESIGN AND METHODS Pregnancy outcome ( pre-eclampsia or gestational hypertension ) was assessed prospect ively in 749 women from the r and omized controlled Diabetes and Pre-eclampsia Intervention Trial ( DAPIT ) . HbA1c  ( A1C )  values were available up to 6 months before pregnancy ( n = 542 ) , at the first antenatal visit ( median 9 weeks ) ( n = 721 ) , at 26 weeks ’ gestation ( n = 592 ) , and at 34 weeks ’ gestation ( n = 519 ) and were categorized as optimal ( < 6.1 % : referent ) , good ( 6.1–6.9 % ) , moderate ( 7.0–7.9 % ) , and poor ( ≥8.0 % ) glycemic control , respectively . RESULTS Pre-eclampsia and gestational hypertension developed in 17 and 11 % of pregnancies , respectively . Women who developed pre-eclampsia had significantly higher A1C values before and during pregnancy compared with women who did not develop pre-eclampsia ( P < 0.05 , respectively ) . In early pregnancy , A1C ≥8.0 % was associated with a significantly increased risk of pre-eclampsia ( odds ratio 3.68 [ 95 % CI 1.17–11.6 ] ) compared with optimal control . At 26 weeks ’ gestation , A1C values ≥6.1 % ( good : 2.09 [ 1.03–4.21 ] ; moderate : 3.20 [ 1.47–7.00 ] ; and poor : 3.81 [ 1.30–11.1 ] ) and at 34 weeks ’ gestation A1C values ≥7.0 % ( moderate : 3.27 [ 1.31–8.20 ] and poor : 8.01 [ 2.04–31.5 ] ) significantly increased the risk of pre-eclampsia compared with optimal control . The adjusted odds ratios for pre-eclampsia for each 1 % decrement in A1C before pregnancy , at the first antenatal visit , at 26 weeks ’ gestation , and at 34 weeks ’ gestation were 0.88 ( 0.75–1.03 ) , 0.75 ( 0.64–0.88 ) , 0.57 ( 0.42–0.78 ) , and 0.47 ( 0.31–0.70 ) , respectively . Glycemic control was not significantly associated with gestational hypertension . CONCLUSIONS Women who developed pre-eclampsia had significantly higher A1C values before and during pregnancy . These data suggest that optimal glycemic control both early and throughout pregnancy may reduce the risk of pre-eclampsia in women with type 1 diabetes In this double-blind study , the effects of ascorbic acid , vitamin B6 , vitamin B12 , and folate supplementation on the maternal nutritional status and vitamin content of breast milk in 16 low socioeconomic lactating women were studied . Nine subjects were administered a commercial multivitamin-multimineral supplement and seven were given placebos . Milk sample s were collected four times per day at 4-h intervals from 5 to 7 and 43 to 45 days postpartum . Fasting blood sample s were taken from all mothers at the end of each milk collection period . Dietary records of all foods consumed were kept from 4 to 7 and 42 to 45 days postpartum . There were no significant differences in milk or plasma levels of ascorbic acid between the unsupplemented and supplemented groups . Both the EGPT index and milk concentration of vitamin B6 were significantly different ( p less than 0.01 ) between the unsupplemented and supplemented groups . The milk concentrations of vitamin B12 increased significantly ( p less than 0.05 ) in the supplemented group , as did the milk concentrations of folate ( p less than 0.01 ) . Because of consistently low levels of dietary vitamin B6 and folic acid in this group of low socioeconomic lactating women , either dietary changes or supplements could be necessary to maintain recommended levels of these vitamins in the womens ' breast milk BACKGROUND Vitamin C is involved in the synthesis and degradation of collagen and is important for maintenance of the chorioamniotic membranes . Inadequate availability of ascorbic acid during pregnancy has been proposed as a risk factor for premature rupture of the chorioamniotic membranes ( PROM ) . OBJECTIVE The objective of the study was to evaluate the effectiveness of 100 mg vitamin C/d in preventing PROM . DESIGN A controlled double-blind trial was performed . Pregnant women ( n = 126 ) in their 20th wk of gestation were invited ; 120 accepted and were r and omly assigned to 2 groups  ( 100 mg vitamin C/d or placebo ) . Every 4 wk , plasma and leukocyte vitamin C concentrations were measured , and each subject was evaluated for cervicovaginal infection . The incidence of PROM was recorded for each group as an indicator of the protective effect of vitamin C supplementation . RESULTS One hundred nine patients finished the study .  Mean plasma vitamin C concentrations decreased significantly throughout the pregnancy in both groups ( P = 0.001 ) , and there were no significant differences between groups . Between weeks 20 and 36 , mean leukocyte vitamin C concentrations decreased from 17.5 to 15.23 microg/10(8 ) cells in the placebo group and increased from 17.26 to 22.17 microg/10(8 ) cells in the supplemented group ( within- and between-group differences : P = 0.001 ) . The incidence of PROM was 14 per 57 pregnancies ( 24.5 % ) in the placebo group and 4 per 52 pregnancies ( 7.69 % ) in the supplemented group ( relative risk : 0.26 ; 95 % CI : 0.078 , 0.837 ) . CONCLUSION Daily supplementation with 100 mg vitamin C after 20 wk of gestation effectively lessens the incidence of PROM Summary Background Results of several trials of antioxidant use during pregnancy have not shown a reduction in pre-eclampsia , but the effect in women with diabetes is unknown . We aim ed to assess whether supplementation with vitamins C and E reduced incidence of pre-eclampsia in women with type 1 diabetes . Methods We enrolled women from 25 UK antenatal metabolic clinics in a multicentre r and omised placebo-controlled trial . Eligibility criteria were type 1 diabetes preceding pregnancy , presentation between 8 weeks ' and 22 weeks ' gestation , singleton pregnancy , and age 16 years or older . Women were r and omly allocated in a 1:1 ratio to receive 1000 mg vitamin C and 400 IU vitamin E ( α-tocopherol ) or matched placebo daily until delivery . The r and omisation sequence was stratified by centre with balanced blocks of eight patients . All trial personnel and participants were masked to treatment allocation . The primary endpoint was pre-eclampsia , which we defined as gestational hypertension with proteinuria . Analysis was by modified intention to treat . This study is registered , IS RCT N27214045 . Findings Between April , 2003 , and June , 2008 , 762 women were r and omly allocated to treatment groups ( 379 vitamin supplementation , 383 placebo ) . The primary endpoint was assessed for 375 women allocated to receive vitamins , and 374 allocated to placebo . Rates of pre-eclampsia did not differ between vitamin ( 15 % , n=57 ) and placebo ( 19 % , 70 ) groups ( risk ratio 0·81 , 95 % CI 0·59–1·12 ) . No adverse maternal or neonatal outcomes were reported . Interpretation Supplementation with vitamins C and E did not reduce risk of pre-eclampsia in women with type 1 diabetes . However , the possibility that vitamin supplementation might be beneficial in women with a low antioxidant status at baseline needs further testing . Funding The Wellcome Trust Background Vitamin C or ascorbic acid is a hydro-soluble lactone ( synthesized from glucose ) essential to human body and available from diet . Despite its broad availability in fruits and vegetables , in many developing countries the incidence of clinical symptoms due to the vitamin deficiency is still very high . Also , pregnant women in the developing countries are frequently hospitalized for several preventable reasons such as anemia in pregnancy , mostly iron-deficient anemia ( IDA ) and the upper/lower respiratory tract infections ( RTI ) . The aim of the study was to investigate , in a Ug and an rural pregnant women cohort , the preventive effects of vitamin C supplementation on hospital admission . Methods 384 pregnant women met the inclusion criteria and were r and omly assigned to receive either 400 mg of vitamin C daily ( 187 ) or not ( 197 ) in addition to their st and ard antenatal vitamins until delivery . The primary outcome measure of this study was to assess the prevention of hospitalization during pregnancy in the group of women supplemented with vitamin C compared to the controls . Fisher‘s exact test was employed in this assessment . Results 42.2 % women in the vitamin C group and 27.9 % in the control group were not hospitalized during pregnancy ; this difference was found statistically significant . Conclusion The results of this study suggest including vitamin C in the guidelines of multivitamin prevention for pregnant women , especially in developing countries where seasonal availability of fruits and vegetables could result in adverse clinical outcomes Background Prenatal antioxidant supplementation might influence fetal lung growth and development and reduce infant respiratory morbidity . The aim of this study was to test the hypothesis that infants of mothers at risk of pre-eclampsia who were r and omised to receive high-dose vitamins C and E ( 1000 mg vitamin C and 400 IU RRR α-tocopherol daily ) during pregnancy would have better respiratory outcomes than infants whose mothers were r and omised to receive placebo . Methods Respiratory outcomes to 2 years of age were documented using question naires and , in a subset , by recording their healthcare utilisation and calculating the cost of care data . Results 330 women who had taken vitamin supplementation and 313 who had taken placebo completed the respiratory question naire ( 386 and 366 infants , respectively ) . There were no significant differences between the two groups in the proportions diagnosed with asthma . 54 women who had taken vitamin supplementation and 45 who had taken placebo  took part in the healthcare utilisation study ( 65 and 53 infants , respectively ) . On average , infants of mothers receiving vitamin supplementation had 2.6 ( 99 % CI 0.8 to 5.1 ) times more A&E/outpatient visits and 3 
    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: Abstract Objective : To investigate the relations of maternal diet and smoking during pregnancy to placental and birth weights at term . Design : Prospect i ve cohort study . Setting : District general hospital in the south of Engl and . Participants : 693 pregnant nulliparous white women with singleton pregnancies who were selected from antenatal booking clinics with stratified r and om sampling . Main outcome measures : Birth and placental weights at term . Results : Placental and birth weights were unrelated to the intake of any macronutrient . Early in pregnancy , vitamin C was the only micronutrient independently associated with birth weight after adjustment for maternal height and smoking . Each ln mg increase in vitamin C was associated with a 50.8 g ( 95 % confidence interval 4.6 g to 97.0 g ) increase in birth weight . Vitamin C , vitamin E , and folate were each associated with placental weight after adjustment for maternal characteristics . In simultaneous regression , however , vitamin C was the only nutrient predictive of placental weight : each ln mg increase in vitamin C was associated with a 3.2 % ( 0.4 to 6.1 ) rise in placental weight . No nutrient late in pregnancy was associated with either placental or birth weight . Conclusions : Concern over the impact of maternal nutrition on the health of the infant has been premature Maternal nutrition , at least in industrialised population s , seems to have only a small effect on placental and birth weights . Other possible determinants of fetal and placental growth should be investigated . Key messages Placental and infant birth weights were not associated with the intake of any macronutrient early or later in pregnancy After adjustment for the effects of maternal height and smoking , only vitamin C independently predicted birth weight . The expected mean difference in birth weight for infants with mothers in the upper and lower thirds of intake was about 70 g Vitamin C was the only nutrient that independently predicted placental weight , but again this relation was of doubtful clinical significance Among relatively well nourished women in industrialised countries , maternal nutrition seems to have only a marginal impact on infant and placental size . Other causes of variation in the size of clinical ly normal infants should now be Objective To determine whether antioxidant therapy alters the disease process in severe early onset pre‐eclampsia , in support of the hypothesis that increased lipid peroxides and reactive oxygen species production play an important role in the pathogenesis of the disease OBJECTIVE To assess the relationship between glycemic control , pre-eclampsia , and gestational hypertension in women with type 1 diabetes . RESEARCH DESIGN AND METHODS Pregnancy outcome ( pre-eclampsia or gestational hypertension ) was assessed prospect ively in 749 women from the r and omized controlled Diabetes and Pre-eclampsia Intervention Trial ( DAPIT ) . HbA1c  ( A1C )  values were available up to 6 months before pregnancy ( n = 542 ) , at the first antenatal visit ( median 9 weeks ) ( n = 721 ) , at 26 weeks ’ gestation ( n = 592 ) , and at 34 weeks ’ gestation ( n = 519 ) and were categorized as optimal ( < 6.1 % : referent ) , good ( 6.1–6.9 % ) , moderate ( 7.0–7.9 % ) , and poor ( ≥8.0 % ) glycemic control , respectively . RESULTS Pre-eclampsia and gestational hypertension developed in 17 and 11 % of pregnancies , respectively . Women who developed pre-eclampsia had significantly higher A1C values before and during pregnancy compared with women who did not develop pre-eclampsia ( P < 0.05 , respectively ) . In early pregnancy , A1C ≥8.0 % was associated with a significantly increased risk of pre-eclampsia ( odds ratio 3.68 [ 95 % CI 1.17–11.6 ] ) compared with optimal control . At 26 weeks ’ gestation , A1C values ≥6.1 % ( good : 2.09 [ 1.03–4.21 ] ; moderate : 3.20 [ 1.47–7.00 ] ; and poor : 3.81 [ 1.30–11.1 ] ) and at 34 weeks ’ gestation A1C values ≥7.0 % ( moderate : 3.27 [ 1.31–8.20 ] and poor : 8.01 [ 2.04–31.5 ] ) significantly increased the risk of pre-eclampsia compared with optimal control . The adjusted odds ratios for pre-eclampsia for each 1 % decrement in A1C before pregnancy , at the first antenatal visit , at 26 weeks ’ gestation , and at 34 weeks ’ gestation were 0.88 ( 0.75–1.03 ) , 0.75 ( 0.64–0.88 ) , 0.57 ( 0.42–0.78 ) , and 0.47 ( 0.31–0.70 ) , respectively . Glycemic control was not significantly associated with gestational hypertension . CONCLUSIONS Women who developed pre-eclampsia had significantly higher A1C values before and during pregnancy . These data suggest that optimal glycemic control both early and throughout pregnancy may reduce the risk of pre-eclampsia in women with type 1 diabetes In this double-blind study , the effects of ascorbic acid , vitamin B6 , vitamin B12 , and folate supplementation on the maternal nutritional status and vitamin content of breast milk in 16 low socioeconomic lactating women were studied . Nine subjects were administered a commercial multivitamin-multimineral supplement and seven were given placebos . Milk sample s were collected four times per day at 4-h intervals from 5 to 7 and 43 to 45 days postpartum . Fasting blood sample s were taken from all mothers at the end of each milk collection period . Dietary records of all foods consumed were kept from 4 to 7 and 42 to 45 days postpartum . There were no significant differences in milk or plasma levels of ascorbic acid between the unsupplemented and supplemented groups . Both the EGPT index and milk concentration of vitamin B6 were significantly different ( p less than 0.01 ) between the unsupplemented and supplemented groups . The milk concentrations of vitamin B12 increased significantly ( p less than 0.05 ) in the supplemented group , as did the milk concentrations of folate ( p less than 0.01 ) . Because of consistently low levels of dietary vitamin B6 and folic acid in this group of low socioeconomic lactating women , either dietary changes or supplements could be necessary to maintain recommended levels of these vitamins in the womens ' breast milk BACKGROUND Vitamin C is involved in the synthesis and degradation of collagen and is important for maintenance of the chorioamniotic membranes . Inadequate availability of ascorbic acid during pregnancy has been proposed as a risk factor for premature rupture of the chorioamniotic membranes ( PROM ) . OBJECTIVE The objective of the study was to evaluate the effectiveness of 100 mg vitamin C/d in preventing PROM . DESIGN A controlled double-blind trial was performed . Pregnant women ( n = 126 ) in their 20th wk of gestation were invited ; 120 accepted and were r and omly assigned to 2 groups  ( 100 mg vitamin C/d or placebo ) . Every 4 wk , plasma and leukocyte vitamin C concentrations were measured , and each subject was evaluated for cervicovaginal infection . The incidence of PROM was recorded for each group as an indicator of the protective effect of vitamin C supplementation . RESULTS One hundred nine patients finished the study .  Mean plasma vitamin C concentrations decreased significantly throughout the pregnancy in both groups ( P = 0.001 ) , and there were no significant differences between groups . Between weeks 20 and 36 , mean leukocyte vitamin C concentrations decreased from 17.5 to 15.23 microg/10(8 ) cells in the placebo group and increased from 17.26 to 22.17 microg/10(8 ) cells in the supplemented group ( within- and between-group differences : P = 0.001 ) . The incidence of PROM was 14 per 57 pregnancies ( 24.5 % ) in the placebo group and 4 per 52 pregnancies ( 7.69 % ) in the supplemented group ( relative risk : 0.26 ; 95 % CI : 0.078 , 0.837 ) . CONCLUSION Daily supplementation with 100 mg vitamin C after 20 wk of gestation effectively lessens the incidence of PROM Summary Background Results of several trials of antioxidant use during pregnancy have not shown a reduction in pre-eclampsia , but the effect in women with diabetes is unknown . We aim ed to assess whether supplementation with vitamins C and E reduced incidence of pre-eclampsia in women with type 1 diabetes . Methods We enrolled women from 25 UK antenatal metabolic clinics in a multicentre r and omised placebo-controlled trial . Eligibility criteria were type 1 diabetes preceding pregnancy , presentation between 8 weeks ' and 22 weeks ' gestation , singleton pregnancy , and age 16 years or older . Women were r and omly allocated in a 1:1 ratio to receive 1000 mg vitamin C and 400 IU vitamin E ( α-tocopherol ) or matched placebo daily until delivery . The r and omisation sequence was stratified by centre with balanced blocks of eight patients . All trial personnel and participants were masked to treatment allocation . The primary endpoint was pre-eclampsia , which we defined as gestational hypertension with proteinuria . Analysis was by modified intention to treat . This study is registered , IS RCT N27214045 . Findings Between April , 2003 , and June , 2008 , 762 women were r and omly allocated to treatment groups ( 379 vitamin supplementation , 383 placebo ) . The primary endpoint was assessed for 375 women allocated to receive vitamins , and 374 allocated to placebo . Rates of pre-eclampsia did not differ between vitamin ( 15 % , n=57 ) and placebo ( 19 % , 70 ) groups ( risk ratio 0·81 , 95 % CI 0·59–1·12 ) . No adverse maternal or neonatal outcomes were reported . Interpretation Supplementation with vitamins C and E did not reduce risk of pre-eclampsia in women with type 1 diabetes . However , the possibility that vitamin supplementation might be beneficial in women with a low antioxidant status at baseline needs further testing . Funding The Wellcome Trust Background Vitamin C or ascorbic acid is a hydro-soluble lactone ( synthesized from glucose ) essential to human body and available from diet . Despite its broad availability in fruits and vegetables , in many developing countries the incidence of clinical symptoms due to the vitamin deficiency is still very high . Also , pregnant women in the developing countries are frequently hospitalized for several preventable reasons such as anemia in pregnancy , mostly iron-deficient anemia ( IDA ) and the upper/lower respiratory tract infections ( RTI ) . The aim of the study was to investigate , in a Ug and an rural pregnant women cohort , the preventive effects of vitamin C supplementation on hospital admission . Methods 384 pregnant women met the inclusion criteria and were r and omly assigned to receive either 400 mg of vitamin C daily ( 187 ) or not ( 197 ) in addition to their st and ard antenatal vitamins until delivery . The primary outcome measure of this study was to assess the prevention of hospitalization during pregnancy in the group of women supplemented with vitamin C compared to the controls . Fisher‘s exact test was employed in this assessment . Results 42.2 % women in the vitamin C group and 27.9 % in the control group were not hospitalized during pregnancy ; this difference was found statistically significant . Conclusion The results of this study suggest including vitamin C in the guidelines of multivitamin prevention for pregnant women , especially in developing countries where seasonal availability of fruits and vegetables could result in adverse clinical outcomes Background Prenatal antioxidant supplementation might influence fetal lung growth and development and reduce infant respiratory morbidity . The aim of this study was to test the hypothesis that infants of mothers at risk of pre-eclampsia who were r and omised to receive high-dose vitamins C and E ( 1000 mg vitamin C and 400 IU RRR α-tocopherol daily ) during pregnancy would have better respiratory outcomes than infants whose mothers were r and omised to receive placebo . Methods Respiratory outcomes to 2 years of age were documented using question naires and , in a subset , by recording their healthcare utilisation and calculating the cost of care data . Results 330 women who had taken vitamin supplementation and 313 who had taken placebo completed the respiratory question naire ( 386 and 366 infants , respectively ) . There were no significant differences between the two groups in the proportions diagnosed with asthma . 54 women who had taken vitamin supplementation and 45 who had taken placebo  took part in the healthcare utilisation study ( 65 and 53 infants , respectively ) . On average , infants of mothers receiving vitamin supplementation had 2.6 ( 99 % CI 0.8 to 5.1 ) times more A&E/outpatient visits and 3 
    Output:
    