Viral infections in pregnancy are a major cause of maternal and fetal mortality/morbidity.The viral infections of concern during pregnancy are caused by cytomegalovirus (CMV) rubella virus and herpes simplex virus (HSV).Other viruses now known to cause congenital infections include varicella-zoster virus (VZS), West Nile virus, measles virus, enterovirus, HIV and Zika virus.Also, hepatitis E is important because of its high mortality rate associated with infection during pregnancy.Mortality and morbidity from Cytomegalovirus and varicella -zoster virus are discussed.

Some of the important pregnancy outcomes such as preterm delivery, growth restriction and low birth weight (LBW) infant, stillbirth, and some long-term chronic diseases vary by race and ethnicity but also tend to be associated with gestational age of the infant at birth. In the United States, during the last 25–30 years, the rate of low birth weight has increased, as has the rate of preterm delivery among both whites and blacks. Examination of causes for these secular trends has focused mainly on changes in the distribution of maternal age, race, and certain psychosocial factors. However, gestational age at birth is associated with most of these pregnancy outcomes, particularly infant mortality, certain morbidities, birth weight, and preterm birth. In this chapter, the association between ges- tational age and some significant pregnancy outcomes will be discussed.

Maternal mortality is a major global concern. Although a notable decline in maternal mortality in the United States occurred during the mid-20th century, this progress stalled during the late 20th century. Furthermore, maternal mortality rates have increased during the early 21st century. Around the year 2000 the maternal mortality rate began to rise and has since nearly doubled. Given that at least half of maternal deaths in the U.S. are preventable, the rise in maternal deaths in the U.S. is historic and worrisome. This overview will try to provide a context for understanding the problem of this rise in maternal mortality in the U.S. by briefly discussing how maternal mortality rates are reported from National Vital Statistics data and from a National Surveillance system. Trends and causes of maternal deaths and the difficulty with interpreting these trends will be discussed.

Malnutrition, though uncommon in developed countries, continues to be a major health burden in developing countries. Malnutrition, consisting of protein-energy malnutrition and micronutrient deficiencies, is globally the most important risk factor for morbidity and mortality. Particularly, hundreds of millions of pregnant women and young children are affected by malnutrition. Forty five percent of all deaths in children fewer than 5 years of age are attributed to under nutrition. In 2012, it was estimated that 26% of the world’s children were stunted and about 3% were severely wasted. In the past decade, discourse about the challenge of malnutrition has increased substantially at both national and international levels. Definition, prevalence, causes and challenges associated with reducing malnutrition (undernutrition) in children, pregnant women and the elderly will be covered briefly in this review. Emphasis of this review is on prevalence and prevention of malnutrition in pregnant women and children. *Corresponding Author: Yasmin Neggers, Department of Human Nutrition, The University of Alabama, Box 870311, Tuscaloosa, Alabama 35487-0311, Tel: 205-348-4706; E-mail: yneggers@ches.ua.edu

Impaired respiration reduces firefighters' work capacity. This study evaluated the effect of menthol lozenge on respiratory and perceptual responses during exercise in a hot environment. Ten participants wearing firefighter protective gear performed two repeated exercise and rest trials in a counter-balanced order. Exercise consisted of two bouts of 20-min treadmill exercise at 60% of maximal oxygen uptake and one bout of 20-min stepping exercise at a wet bulb global temperature of 35 degrees C. Participants either took 10-mg menthol or control lozenges prior to the beginning of each exercise bout. Respiratory gas exchange, heart rate, thermal sensation, and breathing comfort were continuously recorded. Menthol lozenges significantly increased pulmonary ventilation (menthol: 45.0 +/- 6.6 L.min(-1) vs. control: 41.4 +/- 5.8 L.min(-1) and menthol: 52.7 +/- 9.7 L.min(-1) vs. control: 46.5 +/- 7.0 L.min(-1), for the 1st and 2nd treadmill exercise, respectively) and oxygen consumption (menthol: 26.7 +/- 2.0 ml.g(-1).min(-1) vs. control: 25.2 +/- 2.3 ml.g(-1).min(-1) and menthol: 28.8 +/- 2.3 ml.g(-1).min(-1) vs. control: 26.9 +/- 1.9 ml.g(-1).min(-1), for the 1st and 2nd treadmill exercise, respectively) (p<0.05). The effect of menthol on respiration disappeared during the stepping exercise (p>0.05). The ventilatory equivalents though were not different throughout the exercise (p>0.05). Ratings of thermal sensation and breathing comfort were not different (p>0.05). It was concluded that menthol could alter breathing pattern and increase respiratory responses during strenuous exercise in the heat. There was no favorable effect of menthol on respiratory or perceptual responses under exercise-heat stress.

Although vast improvements have been made in the survival of preterm infants, the toll of preterm birth (PTB) is particularly severe in Asia, with the Indian subcontinent leading the preterm birth rate. Despite the obesity epidemic, maternal underweight remains a common occurrence in developing countries. An association between maternal underweight and preterm birth has been reported in developed countries. A review of epidemiological studies in Asian women in whom association between maternal body mass index (BMI) and risk of PTB was measured, indicated no significant association between low maternal BMI and preterm birth. A hindrance in comparison of these studies is the use of different cut-off point for BMI in defining maternal underweight. As a commentary on published studies it is proposed that that country-specific BMI cut points should be applied for defining underweight for Asian women for the purpose of evaluating the association between maternal underweight and preterm birth.

This study examined the separate effects of caffeine and menthol on cognition and mood during simulated firefighting in the heat. Participants (N = 10) performed three trials in a counterbalanced order, either with 400 mg caffeine, menthol lozenges, or placebo. The simulated firefighting consisted of 2 bouts of 20-min treadmill exercise and one bout of 20-min stepping exercise in the heat with two brief 15-min rest periods between each exercise phase. Exercise induced significant dehydration (>3%) and elevated rectal temperature (>38.9 °C), for all three conditions. Neither caffeine nor menthol reduced perceived exertion compared to placebo (p > 0.05). Mood ratings (i.e., alertness, hedonic tone, tension) significantly deteriorated over time (p < 0.05), but there was no difference among the three conditions. Simple reaction time, short-term memory, and retrieval memory did not alter with treatments or repeated evaluations. Reaction accuracy from a math test remained unchanged throughout the experimental period; reaction time from the math test was significantly faster after exposure to the heat (p < 0.05). It is concluded that, exhaustive exercise in the heat severely impacted mood, but minimally impacted cognition. These treatments failed to show ergogenic benefits in a simulated firefighting paradigm in a hot environment.

There is considerable scientific evidence that many aspects of diet influence the occurrence of human disease. Many factors such as genetic, psychological, environmental and behavioral characteristics influence development of human disease, and there is a close relationship between nutrition and disease. Though typical Western diets are not overtly deficient in essential nutrients, nutriture of a few micro nutrients such as folic acid has been reported to be sub-optimal, particularly in women of childbearing age. The role of folic acid in the prevention of macrocytic anemia and neural tube defects is well established. However, the relationship between folic acid and risk of autism is still evolving. Furthermore, environmental as well as nutritional factors such as folic acid are now well acknowledged as interacting with the individual genetic background in development of several diseases. In this article, recent research regarding the relationship between folic acid and risk of autism is evaluated.

Background. The effect of ingestion of a common stimulant, caffeine, on fluid balance during exercise and recovery is not fully known. Objectives. To determine the effect of caffeine on fluid balance during exercise in the heat and during a 3-hour recovery period thereafter. Methods. In a randomised, controlled design, caffeine-naive participants (N=8) pedalled on a bike to achieve 2.5% baseline body mass loss in a hot environment in four separate conditions: with (C+) or without (C–) caffeine ingestion (6 mg/kg of body mass) prior to exercise, followed by (W+) or without (W–) 100% fluid replenishment (water) of the body mass loss during a 3-hour recovery period (yielding C+W+, C+W–, C–W+ and C–W–, respectively). Results. Mean (standard deviation) urine production was not different (p>0.05) regardless of rehydration status: 230 (162) mL (C+W–) v. 168 (77) mL (C–W–); and 713 (201) mL (C+W+) v. 634 (185) mL (C–W+). For the 3-hour recovery, caffeine ingestion caused higher hypohydration during rehydration conditions (p=0.02), but practically the mean difference in the loss of body mass was only 0.2 kg. Conclusion. In practical terms, there was no evidence that caffeine ingestion in moderation would impair fluid balance during prolonged exercise in the heat or during 3 hours of recovery.

Perfluorooctanoate (PFOA) is detectable in umbilical cord blood and amniotic fluid. Some toxicological findings suggest that perfluoroalkyl substances may be teratogenic.Using data from the C8 Health Project, a 2005–2006 survey in a Mid-Ohio Valley community exposed to PFOA through contaminated drinking water, we examined the association between estimated prenatal PFOA concentration and maternally reported birth defects (n = 325) among 10,262 live singleton or multiple births from 1990 to 2006. Logistic regression models accounted for siblings using generalized estimating equations.There was generally no association between estimated PFOA concentration and birth defects, with the possible exception of brain defects, where the odds ratio adjusted for year of conception was 2.6 (95% confidence interval 1.3–5.1) for an increase in estimated PFOA exposure from the 25th to 75th percentile. This estimate, however, was based on 13 cases and may represent a chance finding. Further investigation of this potential association may be warranted.

The frequency of autism spectrum disorders (ASD) diagnoses has been increasing for decades, but researchers cannot agree on whether the trend is a result of increased awareness, improved detection, expanding definition, or an actual increase in incidence or a combination of these factors. Though both genetic and multiple environmental risk factors have been studied extensively, many potentially modifiable risk factors including nutritional and immune function related risk factors such as vitamin D, folic acid, and metabolic syndrome have not received sufficient attention. Several recent studies have put forward hypotheses to explain the mechanism of association between both folic acid and vitamin D and autism. A continuous rise in the prevalence of autism in the USA has coincided with a significant enhancement of maternal folate status with FDA mandated folic acid fortification of certain foods starting in 1998. There is also a growing body of research that suggests that vitamin D status either in utero or early in life may be a risk for autism. In this communication, controversies regarding increase in estimate of prevalence, implications of changes in definition, and possible association between some modifiable nutritional risk factors such as folic acid and vitamin D and ASD will be discussed.

Reducing the incidence of low birth weight (LBW), a major predictor of infant mortality and morbidity in developed and developing countries, is an important worldwide goal, yet interventions to reduce this incidence have been disappointingly unsuccessful. Despite its low per capita income, Cuba has managed to significantly reduce the prevalence of LBW in recent decades. To date, minimal research has been conducted to comparatively evaluate risk factors associated with birth weight outcomes between countries with significantly differing rates of LBW. For this reason, we traveled to Havana to study the Cuban model of prenatal care and compare risk factors associated with LBW in Cuba, the United States, and, in particular, Alabama. This article describes the community-based approaches to prenatal care provided within the Cuban healthcare system and their influence on rates of LBW. As a result of these successfully integrated health services, the Cuban healthcare model will be used to evaluate and compare Alabama's current prenatal care system, in particular the implementation of strategies such as community-based clinics and maternity homes for high-risk pregnancies.

The aim of the study was to assess the association of phthalate metabolites levels in urine with semen parameters (sperm concentration, motility, morphology, CASA parameters), sperm chromatin structure, sperm aneuploidy and reproductive hormones. The study population consisted of 269 men who were attending an infertility clinic and had normal semen concentration (20–300 mln/ml) or slight oligozoospermia (15–20 mln/ml). Participants were interviewed and provided a semen sample. The phthalate metabolites were analysed in the urine using a procedure based on the LC–MS/MS method. Urinary phthalate metabolites levels were significantly associated with a decrease in sperm motility (5OH MEHP, MEHP, MINP), CASA parameters (MBP), testosterone level (MEHP) and an increase sperm DNA damage (MBP) and sperm aneuploidy (MBzP, MBP, MEHP, MEP). In view of the importance of human reproductive health and the widespread usage of phthalates, it is important to further investigate these correlations.

Chromium, vanadium, and zinc are first-row transition metals in the periodic table. Chromium has been accepted as an essential trace element for three decades; however, this status has received serious challenge such that chromium will probably be removed from the list of essential elements for mammals. While chromium(III) apparently can amplify insulin sensitivity at pharmacological doses, overwhelming data indicate it has no effect on body composition and muscle mass of healthy individuals despite claims in the popular literature. Vanadium has never been formally recognized as essential and probably has no role in normal mammalian biology. While vanadium appears to serve as an insulin mimetic, its toxicity prevents its use as a nutritional supplement. Zinc is essential for cellular growth, division and differentiation. Although the highest concentrations of Zn are found in muscle and bone and some evidence exists suggesting that Zn is needed for optimal muscle function, effects of Zn supplementation on sports performance are equivocal.

This review examines the influence of dehydration on muscular strength and endurance and on single and repeated anaerobic splint bouts. Describing hydration effects on anaerobic performance is difficult because various exercise modes are dominated by anaerobic energy pathways, but still contain inherent physiological differences. The critical level of water deficit (similar to 3-4 %; mode dependent) affecting anaerobic performance is larger than the deficit (similar to 2%) impairing endurance performance. A critical performance-duration component (> 30 s) may also exist. Moderate dehydration (similar to 3% body weight; precise threshold depends on work/recovery ratio) impairs repeated anaerobic bouts, which place an increased demand on aerobic metabolism. Interactions between dehydration level, dehydration mode, testing mode, performance duration, and work/recovery ratio during repeated bouts make the dehydration threshold influencing anaerobic performance mode dependent.

The purpose of this study was to evaluate the effects of 3 types of warm-up (WU) on swimming performance, reaction time, and dive distance. In repeated-measures counterbalanced design, National Collegiate Athletic Association Division I swimmers (n = 16) used 3 WUs before performing 50-yd (45.7-m) freestyle swim trials. The WU consisted of (a) no WU, (b) short WU (50-yd at 40% of swimmers' maximal effort and 50-yd at 90%), and (c) regular WU (usual precompetition WU). The mean 50-yd time was significantly faster (p = 0.01) after the regular WU (24.95 ± 1.53 seconds) when compared with that of the short WU (25.26 ± 1.61 seconds). However, individual data indicated that 19% of the participants performed their best in the 50-yd category after short, 37% after no, and 44% after regular WU. Heart rate was significantly higher (p = 0.01) after regular WU (100 ± 13 b·min(-1)) when compared with that of the no WU category (88 ± 18 b·min(-1)). However, no significant differences among WUs were found for reaction time (p = 0.96), rating of perceived exertion post 50-yd time trial (p = 0.11), dive distance (p = 0.67), or stroke count (p = 0.23). In conclusion, the average regular WU was better than short or noWU to achieve the fastest mean time in the 50-yd freestyle; however, some individual performances were faster after WUs different from their regular approach.

Inadequate caloric intake and micronutrient deficiencies may be detrimental to athletic performance and recovery. Therefore, there is a need for athletes to be educated by a health professional about the importance of a well-balanced diet, supplement use and energy requirements for specific to each athlete's sport. The purpose of the present study was to examine dietary intake of essential nutrients and the use of dietary supplements in NCAA Division I female athletes. Eighty athletes from track & field, rowing, and soccer teams completed a 24-hour dietary recall for a week day and dietary supplement survey. Mean energy intake was 2068 +/- 532 kcal/day. The percentage of energy obtained from carbohydrate, protein, total fat and saturated fat to total fat ratio were 47 +/- 9, 18 +/- 6, 36 +/- 8 and 32 +/- 9 %. Cholesterol and fiber intakes were 275 +/- 194 mg and 20 +/- 9 g respectively. Total fat and saturated fat intake exceeded recommendations of the Acceptable Macronutrient Distribution Range (AMDR). Recommended Dietary Allowances (RDA) were met for most of the micronutrients excluding deficiencies for vitamin A (>10%), iron (<10%), and potassium (>10%) (all teams) and calcium (<10%) for rowing and track and field teams. In addition, 78% of athletes reported taking vitamin and/or mineral supplements and 96% reported taking sport specific and other dietary supplements in the past 30 days. The most common supplements used were multivitamins, vitamin C, vitamin B-12, calcium, iron, sports drinks and energy drinks. In conclusion, 24-hour dietary recall for athletes indicate inadequate intake of iron, calcium and vitamin A which are critical for energy metabolism and bone health in young athletes. Nutritional counseling specific to these micronutrients for female athletes is warranted.

This study examined effects of heat exposure with and without dehydration on repeated anaerobic cycling. Males (n = 10) completed 3 trials: control (CT), water-bath heat exposure (∼39°C) to 3% dehydration (with fluid replacement) (HE), and similar heat exposure to 3% dehydration (DEHY). Hematocrit increased significantly from pre to postheat immersion in both HE and DEHY. Participants performed 6 × 15s cycle sprints (30s active recovery). Mean Power (MP) was significantly lower vs. CT (596 ± 66 W) for DEHY (569 ± 72 W), and the difference approached significance for HE (582 ± 76 W, p = 0.07). Peak Power (PP) was significantly lower vs. CT (900 ± 117 W) for HE (870 ± 128 W) and approached significance for DEHY (857 ± 145 W, p = 0.07). Postsprint ratings of perceived exertion was higher during DEHY (6.4 ± 2.0) and HE (6.3 ± 1.6) than CT (5.7 ± 2.1). Combined heat and dehydration impaired MP and PP (decrements greatest in later bouts) with HE performance intermediate to CT and DEHY.

Protein synthesis is increased following resistance training. However, protein degradation is also increased which may result in a net loss of muscle tissue following resistance training, if not attenuated with proper post-exercise nutritional intake. This scenario could lead to a delayed recovery from fatigue and a prolonged soreness response. It is unclear of the ability of an acute administration of a carbohydrate-protein beverage or carbohydrate only beverage to enhance recovery compared to no supplementation in the 24 hours immediately post-exercise. PURPOSE: To examine the recovery capabilities and soreness responses of nine resistance-trained females (ages 19-35) following three sets to failure for eight exercises without supplementation (CON), with post-exercise consumption of a carbohydrate-protein (CP) or a carbohydrate-only (CHO) beverage. METHODS: Recovery was measured as the group mean number of repetitions (REPS) performed using the 10-repetition maximum (10RM) for each exercise at baseline compared to the total following CON, CP or CHO. Soreness (SORE) was also measured using a 100mm visual analog scale. Twenty-four hours of passive recovery was observed between each baseline trial and the follow-up session with a seven-day washout period between each set of trials. RESULTS: After 24 hours, REPS for CP (10.5 1.6 reps) was similar (p > 0.05) to CHO (11.3 2.0 reps) and CON (10.0 1.1 reps). For all conditions, CON, CP, and CHO, soreness was significantly higher than baseline (p < 0.05). Mean soreness for the treatments was not significantly different during CP, CHO, or CON (33.6 21.7mm vs. 25.8 15.9mm vs. 32.3 18.3mm, respectively, p > 0.05). CONCLUSION: Large inter-subject variability existed across all treatments for all variables. The findings suggest that acute supplementation with CHO or CP do not enhance 24-hour recovery compared to CON. Women were able to perform similarly to baseline in each scenario despite experiencing a significant level of soreness.