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: It is recognized that women with gestational diabetes mellitus ( GDM ) who have significantly elevated fasting blood glucose levels are at increased risk for fetal macrosomia and perinatal morbidity if treatment is not provided ( 1,2 ) . The association of milder forms of GDM with perinatal morbidity and mortality remains unclear , primarily because the condition is often confounded with other risk factors such as maternal obesity , age , and parity . Screening for GDM is recommended for most pregnant women , yet it is unknown whether there is a benefit to the identification and treatment of mild carbohydrate intolerance during pregnancy ( 3,4 ) . The present report is an up date of our previous description of a current ongoing r and omized treatment trial for mild GDM ( 5 ) . A r and omized clinical trial of women with mild GDM ( fasting glucose < 95 mg/dl ) is being undertaken that compares perinatal outcomes in those receiving diet therapy and insulin as required versus those r and omized to no specific treatment . This study aims to clarify whether there is utility in identifying and treating women with a normal fasting glucose level who meet st and ard criteria for GDM . We plan to compare perinatal outcomes in women who have been r and omized to diet and /or insulin therapy with women who have been r and omized to no specific treatment . A r and omized treatment trial of mild GDM will clarify whether identification and treatment of mild GDM reduce perinatal morbidity . This information will assist in determining appropriate thresholds for the treatment of GDM . Overall , with broader identification and aggressive treatment , perinatal mortality rates associated with GDM appear to be similar to the nondiabetic population ( 1 ) . Several analyses of 20 years ago did document an increased stillbirth rate for GDM pregnancies that would qualify as preexisting diabetes according to World Health Organization criteria ( 6–9 ) . Below this threshold , the extent to 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 Diabetes in pregnancy is a major public health problem in Mexico .  Nutrition therapy is an important component of treatment . Intensive nutrition intervention has not been implemented for Mexican pregnant women with diabetes . Its effect on different types of diabetes mellitus has not been studied . Purpose The authors assessed the effect of a medical nutrition therapy ( MNT ) program on perinatal complications in Mexico City . Methods Quasi-experimental design with a historical control . Women were assigned to a MNT program ( n = 88 ) and were followed up with every 2 weeks until delivery ( 2004 - 2007 ) . The control group ( n = 86 ) was selected from medical charts ( 2001 - 2003 ) and the same inclusion criteria were used . In each group , 55 % of women had type 2 diabetes mellitus and 45 % had gestational diabetes . The MNT program included a moderate intake of carbohydrate ( 40%-45 % of total energy ) and reduction in energy intake , capillary glucose self-monitoring , and education . The control group received usual hospital routine care . Statistical analysis included descriptive statistics , chi-square , and multivariate logistic regression ( OR , 95 % CI ) as indicated . Results Women in the MNT program had a lower risk of preeclampsia , fewer maternal hospitalization , and neonatal deaths in both types of diabetes . Low birth weight was less frequent only in women with gestational diabetes receiving MNT , while neonatal intensive care unit admissions were lower only in women with type 2 diabetes . Conclusions An intensive MNT program , including counseling , education , and capillary glucose self-monitoring , has a positive effect over preeclampsia , maternal hospitalization , and neonatal death in women with diabetes in pregnancy . MNT guidelines should be implemented in Mexican health care facilities treating diabetes in pregnancy PURPOSE The purpose of this study was to examine the effects of self-monitoring of blood glucose ( SMBG ) on feelings of self-efficacy , dietary compliance , and pregnancy outcomes in women with diet-controlled gestational diabetes mellitus ( GDM ) . METHODS Fifty-eight women with GDM and a fasting blood glucose level < 95 mg/dL were r and omly assigned to 2 groups . The experimental group measured their blood glucose levels 4 times daily using a reflectance meter with memory . Metabolic status  was assessed in the control group by periodic monitoring at prenatal visits . Otherwise the management protocol was identical for both groups . The Diabetes Empowerment Scale was completed at study entry and at 37 weeks gestation to assess feelings of self-efficacy .  Dietary compliance was assessed at each visit . RESULTS Both groups of women achieved excellent glucose control ; only 1 woman in each group required insulin therapy . There were no significant differences with regard to feelings of self-efficacy , dietary compliance , birth weight , gestational age at delivery , Apgar scores , and neonatal complications . Rates of macrosomia , delivery by cesarean section , and occurrence of birth trauma were similar . CONCLUSIONS SMBG appears to have little effect on maternal feelings of self-efficacy , dietary compliance , or pregnancy outcomes in women with diet-controlled GDM The determine the effect of different foods on the blood glucose , 62 commonly eaten foods and sugars were fed individually to groups of 5 to 10 healthy fasting volunteers .  Blood glucose levels were measured over 2 h , and expressed as a percentage of the area under the glucose response curve when the same amount of carbohydrate was taken as glucose . The largest rises were seen with vegetables ( 70 + /- 5 % ) , followed by breakfast cereals ( 65 + /- 5 % ) , cereals and biscuits ( 60 + /- 3 % ) , fruit ( 50 + /- 5 % ) , dairy products ( 35 + /- 1 % ) , and dried legumes ( 31 + /- 3 % ) . A significant negative relationship was seen between fat ( p less than 0.01 ) and protein ( p less than 0.001 ) and postpr and ial glucose rise but not with fiber or sugar content OBJECTIVE Studies in predominantly non-Hispanic white population s have suggested that physical activity during pregnancy is associated with a reduced risk of gestational diabetes mellitus ( GDM ) . There are few such studies in Hispanic women , a group at increased risk for GDM . METHODS We conducted a prospect i ve cohort study of household/caregiving , occupational , sports/exercise , and active living habits and the risk of GDM among 1006 Hispanic ( predominantly Puerto Rican ) prenatal care patients in western Massachusetts from 2000 to 2004 . Prepregnancy , early pregnancy , and midpregnancy physical activity was assessed using the Kaiser Physical Activity Survey . RESULTS A total of 33 women ( 3.3 % ) were diagnosed with GDM , and 119 women ( 11.8 % ) were diagnosed with abnormal glucose tolerance . There were no significant associations between GDM risk and occupational and active living activities  in prepregnancy , early pregnancy , and midpregnancy or with a change in levels of household/caregiving , occupational , and active living activities from prepregnancy to during pregnancy . However , after controlling for age and prepregnancy body mass index ( BMI ) , women in the highest quartile of prepregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.03 ) and midpregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.004 ) household/caregiving activities  as well as midpregnancy sports/exercise ( 0.1 , 95 % CI 0.0 - 0.7 , p(trend ) = 0.12 ) had a reduced risk of GDM compared with women in the lowest quartile . CONCLUSIONS Findings in this Hispanic population , although based on small numbers of cases , are consistent with prior research among predominantly non-Hispanic white population BACKGROUND The fetuses of women with gestational diabetes mellitus are at risk for macrosomia and its attendant complications . The best method of achieving euglycemia in these women and reducing morbidity in their infants is not known . We compared the efficacy of postpr and ial and prepr and ial monitoring in achieving glycemic control in women with gestational diabetes . METHODS We studied 66 women with gestational diabetes mellitus who required insulin therapy at 30 weeks of gestation or earlier . The women were r and omly assigned to have their diabetes managed according to the results of prepr and ial monitoring or postpr and ial monitoring ( one hour after meals ) of blood glucose concentrations . Both groups were also monitored with  fasting blood glucose measurements . The goal of insulin therapy was a prepr and ial value of 60 to 105 mg per deciliter ( 3.3 to 5.9 mmol per liter ) or a postpr and ial value of less than 140 mg per deciliter ( 7.8 mmol per liter ) . Obstetrical data and information on neonatal outcomes were collected . RESULTS The prepregnancy weight , weight gain during pregnancy , gestational age at the diagnosis of diabetes and at delivery , degree of compliance with therapy , and degree of achievement of target blood glucose concentrations were similar in the two groups . The mean ( + /- SD ) change in the glycosylated hemoglobin value was greater in the group in which postpr and ial measurements were used ( -3.0 + /- 2.2 percent vs. 0.6 + /- 1.6 percent , P < 0.001 ) and the infants ' birth weight was lower ( 3469 + /- 668 vs. 3848 + /- 434 g , P = 0.01 ) . Similarly , the infants born to the women in the postpr and ial-monitoring group had a lower rate of neonatal hypoglycemia ( 3 percent vs. 21 percent , P = 0.05 ) , were less often large for gestational age ( 12 percent vs. 42 percent , P = 0.01 ) and were less often delivered by cesarean section because of cephalopelvic disproportion ( 12 percent vs. 36 percent , P = 0.04 ) than those in the prepr and ial-monitoring group . CONCLUSIONS Adjustment of insulin therapy in women with gestational diabetes according to the results of postpr and ial , rather than prepr and ial , blood glucose values improves glycemic control and decreases the risk of neonatal hypoglycemia , macrosomia , and cesarean delivery The study was design ed to identify those pregnant women who are diagnosed as having gestational diabetes by National Diabetes Data Group ( NDDG ) criteria , but normal glucose tolerance ( NGT ) or impaired glucose tolerance ( IGT ) by the World Health Organization ( WHO ) criteria , and to test whether treatment changed the perinatal outcome in those with NGT and IGT . The 216 women with an abnormal 100 g oral glucose tolerance test ( OGTT ) using NDDG criteria were subjected to a 75 g OGTT . Using the WHO criteria , 111 women ( 51 % ) had NGT , 98 ( 45 % ) had IGT and 7 ( 3 % ) had frank diabetes mellitus . Those with NGT and IGT were r and omized into control and treatment groups . The perinatal outcome in these two groups was comparable whether the NGT and IGT groups were analysed together or separately except , that in those who were treated for IGT , smaller babies were born one week earlier than in the control group ( 3407 g vs 3110 g , P less than 0.01 ) . This suggests that the WHO 
    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: It is recognized that women with gestational diabetes mellitus ( GDM ) who have significantly elevated fasting blood glucose levels are at increased risk for fetal macrosomia and perinatal morbidity if treatment is not provided ( 1,2 ) . The association of milder forms of GDM with perinatal morbidity and mortality remains unclear , primarily because the condition is often confounded with other risk factors such as maternal obesity , age , and parity . Screening for GDM is recommended for most pregnant women , yet it is unknown whether there is a benefit to the identification and treatment of mild carbohydrate intolerance during pregnancy ( 3,4 ) . The present report is an up date of our previous description of a current ongoing r and omized treatment trial for mild GDM ( 5 ) . A r and omized clinical trial of women with mild GDM ( fasting glucose < 95 mg/dl ) is being undertaken that compares perinatal outcomes in those receiving diet therapy and insulin as required versus those r and omized to no specific treatment . This study aims to clarify whether there is utility in identifying and treating women with a normal fasting glucose level who meet st and ard criteria for GDM . We plan to compare perinatal outcomes in women who have been r and omized to diet and /or insulin therapy with women who have been r and omized to no specific treatment . A r and omized treatment trial of mild GDM will clarify whether identification and treatment of mild GDM reduce perinatal morbidity . This information will assist in determining appropriate thresholds for the treatment of GDM . Overall , with broader identification and aggressive treatment , perinatal mortality rates associated with GDM appear to be similar to the nondiabetic population ( 1 ) . Several analyses of 20 years ago did document an increased stillbirth rate for GDM pregnancies that would qualify as preexisting diabetes according to World Health Organization criteria ( 6–9 ) . Below this threshold , the extent to 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 Diabetes in pregnancy is a major public health problem in Mexico .  Nutrition therapy is an important component of treatment . Intensive nutrition intervention has not been implemented for Mexican pregnant women with diabetes . Its effect on different types of diabetes mellitus has not been studied . Purpose The authors assessed the effect of a medical nutrition therapy ( MNT ) program on perinatal complications in Mexico City . Methods Quasi-experimental design with a historical control . Women were assigned to a MNT program ( n = 88 ) and were followed up with every 2 weeks until delivery ( 2004 - 2007 ) . The control group ( n = 86 ) was selected from medical charts ( 2001 - 2003 ) and the same inclusion criteria were used . In each group , 55 % of women had type 2 diabetes mellitus and 45 % had gestational diabetes . The MNT program included a moderate intake of carbohydrate ( 40%-45 % of total energy ) and reduction in energy intake , capillary glucose self-monitoring , and education . The control group received usual hospital routine care . Statistical analysis included descriptive statistics , chi-square , and multivariate logistic regression ( OR , 95 % CI ) as indicated . Results Women in the MNT program had a lower risk of preeclampsia , fewer maternal hospitalization , and neonatal deaths in both types of diabetes . Low birth weight was less frequent only in women with gestational diabetes receiving MNT , while neonatal intensive care unit admissions were lower only in women with type 2 diabetes . Conclusions An intensive MNT program , including counseling , education , and capillary glucose self-monitoring , has a positive effect over preeclampsia , maternal hospitalization , and neonatal death in women with diabetes in pregnancy . MNT guidelines should be implemented in Mexican health care facilities treating diabetes in pregnancy PURPOSE The purpose of this study was to examine the effects of self-monitoring of blood glucose ( SMBG ) on feelings of self-efficacy , dietary compliance , and pregnancy outcomes in women with diet-controlled gestational diabetes mellitus ( GDM ) . METHODS Fifty-eight women with GDM and a fasting blood glucose level < 95 mg/dL were r and omly assigned to 2 groups . The experimental group measured their blood glucose levels 4 times daily using a reflectance meter with memory . Metabolic status  was assessed in the control group by periodic monitoring at prenatal visits . Otherwise the management protocol was identical for both groups . The Diabetes Empowerment Scale was completed at study entry and at 37 weeks gestation to assess feelings of self-efficacy .  Dietary compliance was assessed at each visit . RESULTS Both groups of women achieved excellent glucose control ; only 1 woman in each group required insulin therapy . There were no significant differences with regard to feelings of self-efficacy , dietary compliance , birth weight , gestational age at delivery , Apgar scores , and neonatal complications . Rates of macrosomia , delivery by cesarean section , and occurrence of birth trauma were similar . CONCLUSIONS SMBG appears to have little effect on maternal feelings of self-efficacy , dietary compliance , or pregnancy outcomes in women with diet-controlled GDM The determine the effect of different foods on the blood glucose , 62 commonly eaten foods and sugars were fed individually to groups of 5 to 10 healthy fasting volunteers .  Blood glucose levels were measured over 2 h , and expressed as a percentage of the area under the glucose response curve when the same amount of carbohydrate was taken as glucose . The largest rises were seen with vegetables ( 70 + /- 5 % ) , followed by breakfast cereals ( 65 + /- 5 % ) , cereals and biscuits ( 60 + /- 3 % ) , fruit ( 50 + /- 5 % ) , dairy products ( 35 + /- 1 % ) , and dried legumes ( 31 + /- 3 % ) . A significant negative relationship was seen between fat ( p less than 0.01 ) and protein ( p less than 0.001 ) and postpr and ial glucose rise but not with fiber or sugar content OBJECTIVE Studies in predominantly non-Hispanic white population s have suggested that physical activity during pregnancy is associated with a reduced risk of gestational diabetes mellitus ( GDM ) . There are few such studies in Hispanic women , a group at increased risk for GDM . METHODS We conducted a prospect i ve cohort study of household/caregiving , occupational , sports/exercise , and active living habits and the risk of GDM among 1006 Hispanic ( predominantly Puerto Rican ) prenatal care patients in western Massachusetts from 2000 to 2004 . Prepregnancy , early pregnancy , and midpregnancy physical activity was assessed using the Kaiser Physical Activity Survey . RESULTS A total of 33 women ( 3.3 % ) were diagnosed with GDM , and 119 women ( 11.8 % ) were diagnosed with abnormal glucose tolerance . There were no significant associations between GDM risk and occupational and active living activities  in prepregnancy , early pregnancy , and midpregnancy or with a change in levels of household/caregiving , occupational , and active living activities from prepregnancy to during pregnancy . However , after controlling for age and prepregnancy body mass index ( BMI ) , women in the highest quartile of prepregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.03 ) and midpregnancy ( OR = 0.2 , 95 % CI 0.1 - 0.8 , p(trend ) = 0.004 ) household/caregiving activities  as well as midpregnancy sports/exercise ( 0.1 , 95 % CI 0.0 - 0.7 , p(trend ) = 0.12 ) had a reduced risk of GDM compared with women in the lowest quartile . CONCLUSIONS Findings in this Hispanic population , although based on small numbers of cases , are consistent with prior research among predominantly non-Hispanic white population BACKGROUND The fetuses of women with gestational diabetes mellitus are at risk for macrosomia and its attendant complications . The best method of achieving euglycemia in these women and reducing morbidity in their infants is not known . We compared the efficacy of postpr and ial and prepr and ial monitoring in achieving glycemic control in women with gestational diabetes . METHODS We studied 66 women with gestational diabetes mellitus who required insulin therapy at 30 weeks of gestation or earlier . The women were r and omly assigned to have their diabetes managed according to the results of prepr and ial monitoring or postpr and ial monitoring ( one hour after meals ) of blood glucose concentrations . Both groups were also monitored with  fasting blood glucose measurements . The goal of insulin therapy was a prepr and ial value of 60 to 105 mg per deciliter ( 3.3 to 5.9 mmol per liter ) or a postpr and ial value of less than 140 mg per deciliter ( 7.8 mmol per liter ) . Obstetrical data and information on neonatal outcomes were collected . RESULTS The prepregnancy weight , weight gain during pregnancy , gestational age at the diagnosis of diabetes and at delivery , degree of compliance with therapy , and degree of achievement of target blood glucose concentrations were similar in the two groups . The mean ( + /- SD ) change in the glycosylated hemoglobin value was greater in the group in which postpr and ial measurements were used ( -3.0 + /- 2.2 percent vs. 0.6 + /- 1.6 percent , P < 0.001 ) and the infants ' birth weight was lower ( 3469 + /- 668 vs. 3848 + /- 434 g , P = 0.01 ) . Similarly , the infants born to the women in the postpr and ial-monitoring group had a lower rate of neonatal hypoglycemia ( 3 percent vs. 21 percent , P = 0.05 ) , were less often large for gestational age ( 12 percent vs. 42 percent , P = 0.01 ) and were less often delivered by cesarean section because of cephalopelvic disproportion ( 12 percent vs. 36 percent , P = 0.04 ) than those in the prepr and ial-monitoring group . CONCLUSIONS Adjustment of insulin therapy in women with gestational diabetes according to the results of postpr and ial , rather than prepr and ial , blood glucose values improves glycemic control and decreases the risk of neonatal hypoglycemia , macrosomia , and cesarean delivery The study was design ed to identify those pregnant women who are diagnosed as having gestational diabetes by National Diabetes Data Group ( NDDG ) criteria , but normal glucose tolerance ( NGT ) or impaired glucose tolerance ( IGT ) by the World Health Organization ( WHO ) criteria , and to test whether treatment changed the perinatal outcome in those with NGT and IGT . The 216 women with an abnormal 100 g oral glucose tolerance test ( OGTT ) using NDDG criteria were subjected to a 75 g OGTT . Using the WHO criteria , 111 women ( 51 % ) had NGT , 98 ( 45 % ) had IGT and 7 ( 3 % ) had frank diabetes mellitus . Those with NGT and IGT were r and omized into control and treatment groups . The perinatal outcome in these two groups was comparable whether the NGT and IGT groups were analysed together or separately except , that in those who were treated for IGT , smaller babies were born one week earlier than in the control group ( 3407 g vs 3110 g , P less than 0.01 ) . This suggests that the WHO 
    Output:
    