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 Higher heme iron intake is associated with increased  type 2 diabetes risk .  However , no previous study has evaluated gestational diabetes mellitus ( GDM ) risk in relation to heme iron intake during pregnancy . We investigated associations of maternal preconceptional and early pregnancy heme and nonheme iron intake with subsequent GDM risk . RESEARCH DESIGN AND METHODS We conducted a prospect i ve cohort study of 3,158 pregnant women . A food frequency question naire was used to assess maternal diet . Multivariable generalized linear regression models were used to derive estimates of relative risks ( RRs ) and 95 % CIs . RESULTS Approximately 5.0 % of the cohort developed GDM ( n = 158 ) . Heme iron intake was positively and significantly associated with GDM risk ( Ptrend = 0.04 ) . After adjusting for confounders , women reporting the highest heme iron intake levels ( ≥1.52 vs. < 0.48 mg per day ) experienced a 3.31-fold – increased GDM risk ( 95 % CI 1.02–10.72 ) . In fully adjusted models , we noted that a 1-mg per day increase in heme iron was associated with a 51 % increased GDM risk ( RR 1.51 [ 95 % CI 0.99–2.36 ] ) . Nonheme iron was inversely , though not statistically significantly , associated with GDM risk , and the corresponding RRs were 1.00 , 0.83 , 0.62 , and 0.61 across quartiles of nonheme iron intake ( Ptrend = 0.08 ) . CONCLUSIONS High levels of dietary heme iron intake during the preconceptional and early pregnancy period may be associated with increased GDM risk . Associations of GDM risk  with dietary nonheme iron intake are less clear . Confirmation of these findings by future studies is warranted OBJECTIVE It is important to identify modifiable factors that may lower gestational diabetes mellitus ( GDM ) risk .  Dietary iron is of particular interest given that iron is a strong prooxidant , and high body iron levels can damage pancreatic β-cell function and impair glucose metabolism . The current study is to determine if prepregnancy dietary and supplemental iron intakes are associated with the risk of GDM . RESEARCH DESIGN AND METHODS A prospect i ve study was conducted among 13,475 women who reported a singleton pregnancy between 1991 and 2001 in the Nurses ’ Health Study II . A total of 867 incident GDM cases were reported . Pooled logistic regression was used to estimate the relative risk ( RR ) of GDM by quintiles of iron intake controlling for dietary and nondietary risk factors . RESULTS  Dietary heme iron intake was positively and significantly associated with GDM risk . After adjusting for age , BMI , and other risk factors , RRs ( 95 % CIs ) across increasing quintiles of heme iron were 1.0 ( reference ) , 1.11 ( 0.87–1.43 ) , 1.31 ( 1.03–1.68 ) , 1.51 ( 1.17–1.93 ) , and 1.58 ( 1.21–2.08 ) , respectively ( P for linear trend 0.0001 ) . The multivariate adjusted RR for GDM associated with every 0.5-mg per day of increase in intake was 1.22 ( 1.10–1.36 ) . No significant associations were observed between total dietary , nonheme , or supplemental iron intake and GDM risk . CONCLUSIONS These findings suggest that higher prepregnancy intake of dietary heme iron is associated with an increased GDM risk Background The costs of gestational diabetes mellitus ( GDM ) screening have been frequently reported , but total GDM-related health care costs compared to the health care costs of women without GDM have not been reported . The aim of this study was to analyse GDM-related health care costs among women with an elevated risk of GDM . Methods The study was based on a cluster-r and omised GDM prevention trial ( N = 848 ) carried out at maternity clinics , combined with data from the Finnish Medical Birth Register and Care Registers for Social Welfare and Health Care . Costs of outpatient visits to primary and secondary care , cost of inpatient hospital care before and after delivery , the use of insulin , delivery costs and babies ’ stay in the neonatal intensive care unit were analysed . Women who developed GDM were compared to those who were not diagnosed with GDM . Results Total mean health care costs adjusted for age , body mass index and education were 25.1 % higher among women diagnosed with GDM ( € 6,432 vs. € 5,143 , p < 0.001 ) than among women without GDM . The cost of inpatient visits was 44 % higher and neonatal intensive care unit use was 49 % higher in the GDM group than among women without GDM . The delivery costs were the largest single component in both groups . Conclusions A confirmed GDM diagnosis was associated with a significant increase in total health care costs . Effective lifestyle counselling by primary health care providers may offer a means of reducing the high costs of secondary care Pregnancy presents a unique époque in life with considerable potential to influence not only maternal health but also the health of the next generation . Nutritional interventions in pregnancy can influence maternal , foetal and infant health . This chapter describes the findings of a large r and omised controlled trial on the impact of a  low glycaemic index diet on  maternal and foetal health  and discusses areas of future research in this important area Background Maternal obesity is associated with an increased risk of pregnancy complications , including gestational diabetes . Physical activity ( PA ) might improve glucose metabolism and reduce the incidence of gestational diabetes . The purpose of this study was to explore patterns of PA and factors associated with change in PA in obese pregnant women . Methods PA was assessed objective ly by accelerometer at 16 – 18 weeks ’ ( T0 ) , 27 – 28 weeks ’ ( T1 ) and 35 – 36 weeks ’ gestation ( T2 ) in 183 obese pregnant women recruited to a pilot r and omised trial of a combined diet and PA intervention ( the UPBEAT study ) . Results Valid PA data were available for 140 ( 77 % ) , 76 ( 42 % ) and 54 ( 30 % ) women at T0 , T1 and T2 respectively . Moderate and vigorous physical activity as a proportion of accelerometer wear time declined with gestation from a median of 4.8 % at T0 to 3 % at T2 ( p < 0.05 ) . Total activity as a proportion of accelerometer wear time did not change . Being more active in early pregnancy was associated with a higher level of PA later in pregnancy . The intervention had no effect on PA . Conclusions PA in early pregnancy was the factor most strongly associated with PA at later gestations . Women should be encouraged to participate in PA before becoming pregnant and to maintain their activity levels during pregnancy . There is a need for effective interventions , tailored to the needs of individuals and delivered early in pregnancy to support obese women to be sufficiently active during pregnancy . Trial registration Current Controlled Trials IS RCT N89971375 ( Registered 28/11/2008 ) Background Despite the widespread recognition that obesity in pregnant women is associated with adverse outcomes for mother and child , there is no intervention proven to reduce the risk of these complications . The primary aim of this r and omised controlled trial is to assess in obese pregnant women , whether a complex behavioural intervention , based on changing diet ( to foods with a lower glycemic index ) and physical activity , will reduce the risk of gestational diabetes ( GDM ) and delivery of a large for gestational age ( LGA ) infant . A secondary aim is to determine whether the intervention lowers the long term risk of obesity in the offspring . Methods / Design Multicentre r and omised controlled trial comparing a behavioural intervention design ed to improve glycemic control with st and ard antenatal care in obese pregnant women . Inclusion criteria ; women with a BMI ≥30 kg/m2 and a singleton pregnancy between 15 + 0 weeks and 18 + 6 weeks ’ gestation . Exclusion criteria ; pre-defined , pre-existing diseases and multiple pregnancy . R and omisation is on-line by a computer generated programme and is minimised by BMI category , maternal age , ethnicity , parity and centre . Intervention ; this is delivered by a health trainer over 8 sessions . Based on control theory , with elements of social cognitive theory , the intervention is design ed to improve maternal glycemic control . Women r and omised to the control arm receive st and ard antenatal care until delivery according to local guidelines . All women have a 75 g oral glucose tolerance test at 27 + 0- 28 + 6 weeks ’ gestation . Primary outcome ; Maternal : diagnosis of GDM , according to the International Association of Diabetes in Pregnancy Study Group ( IADPSG ) criteria . Neonatal ; infant LGA defined as > 90th customised birth weight centile . Sample size ; 1546 women to provide 80 % power to detect a 25 % reduction in the incidence of GDM and a 30 % reduction in infants large for gestational age . Discussion All aspects of this protocol have been evaluated in a pilot r and omised controlled trial , with subsequent optimisation of the intervention . The findings of this trial will inform whether lifestyle mediated improvement of glycemic control in obese pregnant women can minimise the risk of pregnancy complications . Trial registration Current controlled trials ; IS RCT N89971375 Background The in utero environment is known to affect fetal development however many of the mechanisms by which this occurs remain unknown . The aim of this study was to examine the association between maternal dietary macronutrient intake and lifestyle throughout pregnancy and neonatal weight and adiposity . Methods This was an analysis of 542 mother and infant pairs from the ROLO study ( R and omised cOntrol trial of LOw glycaemic index diet versus no dietary intervention to prevent recurrence of fetal macrosomia ) . Food diaries as well as food frequency and lifestyle and physical activity question naires were completed during pregnancy . Maternal anthropometry was measured throughout pregnancy and neonatal anthropometry was measured at birth . Results Multiple linear regression analysis revealed the main maternal factor associated with increased birth weight was greater gestational weight gain R2adj23.3 % ( F = 11.547 , p < 0.001 ) . The main maternal factor associated with increased birth length was non-smoking status R2adj27.8 % ( F = 6.193 , p < 0.001 ) . Neonatal central adiposity ( determined using waist : length ratio ) was negatively associated with maternal age , and positively associated with the following parameters : smoking status , maternal pre-pregnancy arm circumference , percentage energy from saturated fat in late pregnancy , postpr and ial glucose at 28 weeks gestation and membership of the control group with a positive trend towards association with trimester 2 glycaemic load R2adj 38.1 % ( F = 8.000 , p < 0.001 ) . Conclusions Several maternal diet and lifestyle factors were associated with neonatal anthropometry .  Low glycaemic index dietary intervention in pregnancy was found to have a beneficial effect on neonatal central adiposity . Additionally , central adiposity was positively associated with maternal dietary fat intake and postpr and ial glucose highlighting the important role of healthy diet in pregnancy in promoting normal neonatal adiposity . Trial registration Current Controlled Trials IS RCT N54392969 Higher egg and cholesterol intakes are associated with increased risk of type 2 diabetes mellitus .  However , their association with gestational diabetes mellitus ( GDM ) has not been evaluated . The authors assessed such associations in both a prospect i ve cohort study ( 1996 - 2008 ; 3,158 participants ) and a case-control study ( 1998 - 2002 ; 185 cases , 411 controls ) .  A food frequency question naire was used to assess maternal diet . Multivariable models were used to derive relative risks and 95 % confidence intervals . Compared with no egg consumption , adjusted relative risks for GDM were 0.94 , 1.01 , 1.12 , 1.54 , and 2.52 for consumption of ≤1 , 2 - 3 , 4 - 6 , 7 - 9 , and ≥10 eggs/week , respectively ( P for trend=0.008 ) . Women with high egg consumption ( ≥7/week ) had a 1.77-fold increased risk compared with women with lower consumption ( 95 % confidence interval ( CI ) : 1.19 , 2.63 ) . The relative risk for the highest quartile of cholesterol intake ( ≥294 mg/day ) versus the lowest ( < 151 mg/day ) was 2.35 ( 95 % CI : 1.35 , 4.09 ) . In the case-control study , the adjusted odds ratio for consuming ≥7 eggs/week versus < 7 eggs/week was 2.65 ( 95 % CI : 1.48 , 4.72 ) , and the odds of GDM increased with increasing cholesterol intake ( P for trend=0.021 ) . In conclusion ,  high  egg and cholesterol intakes before and during pregnancy are associated with increased risk of GDM Balanced glucose 
    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 Higher heme iron intake is associated with increased  type 2 diabetes risk .  However , no previous study has evaluated gestational diabetes mellitus ( GDM ) risk in relation to heme iron intake during pregnancy . We investigated associations of maternal preconceptional and early pregnancy heme and nonheme iron intake with subsequent GDM risk . RESEARCH DESIGN AND METHODS We conducted a prospect i ve cohort study of 3,158 pregnant women . A food frequency question naire was used to assess maternal diet . Multivariable generalized linear regression models were used to derive estimates of relative risks ( RRs ) and 95 % CIs . RESULTS Approximately 5.0 % of the cohort developed GDM ( n = 158 ) . Heme iron intake was positively and significantly associated with GDM risk ( Ptrend = 0.04 ) . After adjusting for confounders , women reporting the highest heme iron intake levels ( ≥1.52 vs. < 0.48 mg per day ) experienced a 3.31-fold – increased GDM risk ( 95 % CI 1.02–10.72 ) . In fully adjusted models , we noted that a 1-mg per day increase in heme iron was associated with a 51 % increased GDM risk ( RR 1.51 [ 95 % CI 0.99–2.36 ] ) . Nonheme iron was inversely , though not statistically significantly , associated with GDM risk , and the corresponding RRs were 1.00 , 0.83 , 0.62 , and 0.61 across quartiles of nonheme iron intake ( Ptrend = 0.08 ) . CONCLUSIONS High levels of dietary heme iron intake during the preconceptional and early pregnancy period may be associated with increased GDM risk . Associations of GDM risk  with dietary nonheme iron intake are less clear . Confirmation of these findings by future studies is warranted OBJECTIVE It is important to identify modifiable factors that may lower gestational diabetes mellitus ( GDM ) risk .  Dietary iron is of particular interest given that iron is a strong prooxidant , and high body iron levels can damage pancreatic β-cell function and impair glucose metabolism . The current study is to determine if prepregnancy dietary and supplemental iron intakes are associated with the risk of GDM . RESEARCH DESIGN AND METHODS A prospect i ve study was conducted among 13,475 women who reported a singleton pregnancy between 1991 and 2001 in the Nurses ’ Health Study II . A total of 867 incident GDM cases were reported . Pooled logistic regression was used to estimate the relative risk ( RR ) of GDM by quintiles of iron intake controlling for dietary and nondietary risk factors . RESULTS  Dietary heme iron intake was positively and significantly associated with GDM risk . After adjusting for age , BMI , and other risk factors , RRs ( 95 % CIs ) across increasing quintiles of heme iron were 1.0 ( reference ) , 1.11 ( 0.87–1.43 ) , 1.31 ( 1.03–1.68 ) , 1.51 ( 1.17–1.93 ) , and 1.58 ( 1.21–2.08 ) , respectively ( P for linear trend 0.0001 ) . The multivariate adjusted RR for GDM associated with every 0.5-mg per day of increase in intake was 1.22 ( 1.10–1.36 ) . No significant associations were observed between total dietary , nonheme , or supplemental iron intake and GDM risk . CONCLUSIONS These findings suggest that higher prepregnancy intake of dietary heme iron is associated with an increased GDM risk Background The costs of gestational diabetes mellitus ( GDM ) screening have been frequently reported , but total GDM-related health care costs compared to the health care costs of women without GDM have not been reported . The aim of this study was to analyse GDM-related health care costs among women with an elevated risk of GDM . Methods The study was based on a cluster-r and omised GDM prevention trial ( N = 848 ) carried out at maternity clinics , combined with data from the Finnish Medical Birth Register and Care Registers for Social Welfare and Health Care . Costs of outpatient visits to primary and secondary care , cost of inpatient hospital care before and after delivery , the use of insulin , delivery costs and babies ’ stay in the neonatal intensive care unit were analysed . Women who developed GDM were compared to those who were not diagnosed with GDM . Results Total mean health care costs adjusted for age , body mass index and education were 25.1 % higher among women diagnosed with GDM ( € 6,432 vs. € 5,143 , p < 0.001 ) than among women without GDM . The cost of inpatient visits was 44 % higher and neonatal intensive care unit use was 49 % higher in the GDM group than among women without GDM . The delivery costs were the largest single component in both groups . Conclusions A confirmed GDM diagnosis was associated with a significant increase in total health care costs . Effective lifestyle counselling by primary health care providers may offer a means of reducing the high costs of secondary care Pregnancy presents a unique époque in life with considerable potential to influence not only maternal health but also the health of the next generation . Nutritional interventions in pregnancy can influence maternal , foetal and infant health . This chapter describes the findings of a large r and omised controlled trial on the impact of a  low glycaemic index diet on  maternal and foetal health  and discusses areas of future research in this important area Background Maternal obesity is associated with an increased risk of pregnancy complications , including gestational diabetes . Physical activity ( PA ) might improve glucose metabolism and reduce the incidence of gestational diabetes . The purpose of this study was to explore patterns of PA and factors associated with change in PA in obese pregnant women . Methods PA was assessed objective ly by accelerometer at 16 – 18 weeks ’ ( T0 ) , 27 – 28 weeks ’ ( T1 ) and 35 – 36 weeks ’ gestation ( T2 ) in 183 obese pregnant women recruited to a pilot r and omised trial of a combined diet and PA intervention ( the UPBEAT study ) . Results Valid PA data were available for 140 ( 77 % ) , 76 ( 42 % ) and 54 ( 30 % ) women at T0 , T1 and T2 respectively . Moderate and vigorous physical activity as a proportion of accelerometer wear time declined with gestation from a median of 4.8 % at T0 to 3 % at T2 ( p < 0.05 ) . Total activity as a proportion of accelerometer wear time did not change . Being more active in early pregnancy was associated with a higher level of PA later in pregnancy . The intervention had no effect on PA . Conclusions PA in early pregnancy was the factor most strongly associated with PA at later gestations . Women should be encouraged to participate in PA before becoming pregnant and to maintain their activity levels during pregnancy . There is a need for effective interventions , tailored to the needs of individuals and delivered early in pregnancy to support obese women to be sufficiently active during pregnancy . Trial registration Current Controlled Trials IS RCT N89971375 ( Registered 28/11/2008 ) Background Despite the widespread recognition that obesity in pregnant women is associated with adverse outcomes for mother and child , there is no intervention proven to reduce the risk of these complications . The primary aim of this r and omised controlled trial is to assess in obese pregnant women , whether a complex behavioural intervention , based on changing diet ( to foods with a lower glycemic index ) and physical activity , will reduce the risk of gestational diabetes ( GDM ) and delivery of a large for gestational age ( LGA ) infant . A secondary aim is to determine whether the intervention lowers the long term risk of obesity in the offspring . Methods / Design Multicentre r and omised controlled trial comparing a behavioural intervention design ed to improve glycemic control with st and ard antenatal care in obese pregnant women . Inclusion criteria ; women with a BMI ≥30 kg/m2 and a singleton pregnancy between 15 + 0 weeks and 18 + 6 weeks ’ gestation . Exclusion criteria ; pre-defined , pre-existing diseases and multiple pregnancy . R and omisation is on-line by a computer generated programme and is minimised by BMI category , maternal age , ethnicity , parity and centre . Intervention ; this is delivered by a health trainer over 8 sessions . Based on control theory , with elements of social cognitive theory , the intervention is design ed to improve maternal glycemic control . Women r and omised to the control arm receive st and ard antenatal care until delivery according to local guidelines . All women have a 75 g oral glucose tolerance test at 27 + 0- 28 + 6 weeks ’ gestation . Primary outcome ; Maternal : diagnosis of GDM , according to the International Association of Diabetes in Pregnancy Study Group ( IADPSG ) criteria . Neonatal ; infant LGA defined as > 90th customised birth weight centile . Sample size ; 1546 women to provide 80 % power to detect a 25 % reduction in the incidence of GDM and a 30 % reduction in infants large for gestational age . Discussion All aspects of this protocol have been evaluated in a pilot r and omised controlled trial , with subsequent optimisation of the intervention . The findings of this trial will inform whether lifestyle mediated improvement of glycemic control in obese pregnant women can minimise the risk of pregnancy complications . Trial registration Current controlled trials ; IS RCT N89971375 Background The in utero environment is known to affect fetal development however many of the mechanisms by which this occurs remain unknown . The aim of this study was to examine the association between maternal dietary macronutrient intake and lifestyle throughout pregnancy and neonatal weight and adiposity . Methods This was an analysis of 542 mother and infant pairs from the ROLO study ( R and omised cOntrol trial of LOw glycaemic index diet versus no dietary intervention to prevent recurrence of fetal macrosomia ) . Food diaries as well as food frequency and lifestyle and physical activity question naires were completed during pregnancy . Maternal anthropometry was measured throughout pregnancy and neonatal anthropometry was measured at birth . Results Multiple linear regression analysis revealed the main maternal factor associated with increased birth weight was greater gestational weight gain R2adj23.3 % ( F = 11.547 , p < 0.001 ) . The main maternal factor associated with increased birth length was non-smoking status R2adj27.8 % ( F = 6.193 , p < 0.001 ) . Neonatal central adiposity ( determined using waist : length ratio ) was negatively associated with maternal age , and positively associated with the following parameters : smoking status , maternal pre-pregnancy arm circumference , percentage energy from saturated fat in late pregnancy , postpr and ial glucose at 28 weeks gestation and membership of the control group with a positive trend towards association with trimester 2 glycaemic load R2adj 38.1 % ( F = 8.000 , p < 0.001 ) . Conclusions Several maternal diet and lifestyle factors were associated with neonatal anthropometry .  Low glycaemic index dietary intervention in pregnancy was found to have a beneficial effect on neonatal central adiposity . Additionally , central adiposity was positively associated with maternal dietary fat intake and postpr and ial glucose highlighting the important role of healthy diet in pregnancy in promoting normal neonatal adiposity . Trial registration Current Controlled Trials IS RCT N54392969 Higher egg and cholesterol intakes are associated with increased risk of type 2 diabetes mellitus .  However , their association with gestational diabetes mellitus ( GDM ) has not been evaluated . The authors assessed such associations in both a prospect i ve cohort study ( 1996 - 2008 ; 3,158 participants ) and a case-control study ( 1998 - 2002 ; 185 cases , 411 controls ) .  A food frequency question naire was used to assess maternal diet . Multivariable models were used to derive relative risks and 95 % confidence intervals . Compared with no egg consumption , adjusted relative risks for GDM were 0.94 , 1.01 , 1.12 , 1.54 , and 2.52 for consumption of ≤1 , 2 - 3 , 4 - 6 , 7 - 9 , and ≥10 eggs/week , respectively ( P for trend=0.008 ) . Women with high egg consumption ( ≥7/week ) had a 1.77-fold increased risk compared with women with lower consumption ( 95 % confidence interval ( CI ) : 1.19 , 2.63 ) . The relative risk for the highest quartile of cholesterol intake ( ≥294 mg/day ) versus the lowest ( < 151 mg/day ) was 2.35 ( 95 % CI : 1.35 , 4.09 ) . In the case-control study , the adjusted odds ratio for consuming ≥7 eggs/week versus < 7 eggs/week was 2.65 ( 95 % CI : 1.48 , 4.72 ) , and the odds of GDM increased with increasing cholesterol intake ( P for trend=0.021 ) . In conclusion ,  high  egg and cholesterol intakes before and during pregnancy are associated with increased risk of GDM Balanced glucose 
    Output:
    