{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T18:01:48Z","timestamp":1785607308828,"version":"3.56.0"},"reference-count":73,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2020,11,17]],"date-time":"2020-11-17T00:00:00Z","timestamp":1605571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>The impact of pre-pregnancy obesity and maternal diet quality on the use of healthcare resources during the perinatal period is underexplored. We assessed the effects of body mass index (BMI) and diet quality on the use of healthcare resources, to identify whether maternal diet quality may be effectively targeted to reduce antenatal heath care resource use, independent of women\u2019s BMI. Cross-sectional data and inpatient medical records were gathered from pregnant women attending publicly funded antenatal outpatient clinics in Newcastle, Australia. Dietary intake was self-reported, using the Australian Eating Survey (AES) food frequency questionnaire, and diet quality was quantified from the AES subscale, the Australian Recommended Food Score (ARFS). Mean pre-pregnancy BMI was 28.8 kg\/m2 (range: 14.7 kg\/m2\u201364 kg\/m2). Mean ARFS was 28.8 (SD = 13.1). Higher BMI was associated with increased odds of caesarean delivery; women in obese class II (35.0\u201339.9 kg\/m2) had significantly higher odds of caesarean delivery compared to women of normal weight, (OR = 2.13, 95% CI 1.03 to 4.39; p = 0.04). Using Australian Refined Diagnosis Related Group categories for birth admission, the average cost of the birth admission was $1348 more for women in the obese class II, and $1952 more for women in the obese class III, compared to women in a normal BMI weight class. Higher ARFS was associated with a small statistically significant reduction in maternal length of stay (RR = 1.24, 95% CI 1.00, 1.54; p = 0.05). There was no evidence of an association between ARFS and mode of delivery or \u201cmidwifery-in-the-home-visits\u201d.<\/jats:p>","DOI":"10.3390\/nu12113532","type":"journal-article","created":{"date-parts":[[2020,11,17]],"date-time":"2020-11-17T11:02:12Z","timestamp":1605610932000},"page":"3532","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Maternal Diet Quality, Body Mass Index and Resource Use in the Perinatal Period: An Observational Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0036-1549","authenticated-orcid":false,"given":"Zoe","family":"Szewczyk","sequence":"first","affiliation":[{"name":"Hunter Medical Research Institute (HMRI) Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia"},{"name":"School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9640-1647","authenticated-orcid":false,"given":"Natasha","family":"Weaver","sequence":"additional","affiliation":[{"name":"Hunter Medical Research Institute (HMRI) Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia"},{"name":"School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1303-2063","authenticated-orcid":false,"given":"Megan","family":"Rollo","sequence":"additional","affiliation":[{"name":"School of Health Sciences, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia"},{"name":"Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Deeming","sequence":"additional","affiliation":[{"name":"Hunter Medical Research Institute (HMRI) Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia"},{"name":"School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Holliday","sequence":"additional","affiliation":[{"name":"Hunter Medical Research Institute (HMRI) Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia"},{"name":"School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penny","family":"Reeves","sequence":"additional","affiliation":[{"name":"Hunter Medical Research Institute (HMRI) Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia"},{"name":"School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3298-756X","authenticated-orcid":false,"given":"Clare","family":"Collins","sequence":"additional","affiliation":[{"name":"School of Health Sciences, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia"},{"name":"Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"(1981). The Royal Australian College of Obstetricians and Gynaecologists. Aust. N. Z. J. Obstet. Gynaecol., 21, 128.","DOI":"10.1111\/j.1479-828X.1981.tb00800.x"},{"key":"ref_2","unstructured":"Australian Institute of Health and Welfare (2019). Australia\u2019s Mothers and Babies 2017\u2014In Brief, AIHW."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"87","DOI":"10.7453\/gahmj.2015.094","article-title":"Factors Associated with Excessive Gestational Weight Gain: Review of Current Literature","volume":"5","author":"Samura","year":"2016","journal-title":"Glob. Adv. Health Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1007\/s10995-016-2216-5","article-title":"Rates and Predictors of Caesarean Section for First and Second Births: A Prospective Cohort of Australian Women","volume":"21","author":"Hure","year":"2017","journal-title":"Matern. Child Health J."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Al Mamun, A., Callaway, L., O\u2019Callaghan, M., Williams, G.M., Najman, J.M., Alati, R., Clavarino, A.M., and Lawlor, D.A. (2011). Associations of maternal pre-pregnancy obesity and excess pregnancy weight gains with adverse pregnancy outcomes and length of hospital stay. BMC Pregnancy Childbirth, 11.","DOI":"10.1186\/1471-2393-11-62"},{"key":"ref_6","unstructured":"Department of Health (2018). Clinical Practice Guidelines: Pregnancy Care, Australian Government Department of Health."},{"key":"ref_7","unstructured":"The Royal Hospital for Women (2014). Obesity and Weight Gain in Pregnancy, Labour and Postpartum in Local Operating Procedure: Clinical Guidelines, Procedures and Policies, The Royal Hospital for Women."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1017\/S1368980008003212","article-title":"Diet and pregnancy status in Australian women","volume":"12","author":"Hure","year":"2009","journal-title":"Public Health Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Blumfield, M.L., Hure, A.J., MacDonald-Wicks, L.K., Patterson, A.J., Smith, R., and Collins, C.E. (2011). Disparities exist between National food group recommendations and the dietary intakes of women. BMC Women\u2019s Health, 11.","DOI":"10.1186\/1472-6874-11-37"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Szewczyk, Z., Holliday, E., Dean, B., Collins, C., and Reeves, P. (2020). A systematic review of economic evaluations of antenatal nutrition and alcohol interventions and their associated implementation interventions. Nutr. Rev.","DOI":"10.1093\/nutrit\/nuaa015"},{"key":"ref_11","unstructured":"McDaid, D., Sasso, F., and Merkur, S. (2015). Promoting Health, Preventing Disease: The Economic Case, World Health Organization."},{"key":"ref_12","unstructured":"Independent Hospital Pricing Authority (2017). Bundled Pricing for Maternity Care, in Final Report of IHPA and the Bundled Pricing Advisory Group, IHPA."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Australian Institute of Health and Welfare (2018). Australias Health 2018, AIHW.","DOI":"10.21820\/23987073.2018.2.80"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e008357","DOI":"10.1136\/bmjopen-2015-008357","article-title":"Obesity in pregnancy: Infant health service utilisation and costs on the NHS","volume":"5","author":"Morgan","year":"2015","journal-title":"BMJ Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1111\/dme.12678","article-title":"Short- and long-term effects of gestational diabetes mellitus on healthcare cost: A cross-sectional comparative study in the ATLANTIC DIP cohort","volume":"32","author":"Danyliv","year":"2015","journal-title":"Diabet. Med."},{"key":"ref_16","first-page":"103","article-title":"Health economic modeling to assess short-term costs of maternal overweight, gestational diabetes, and related macrosomia a pilot evaluation","volume":"6","author":"Egarssen","year":"2015","journal-title":"Front. Pharmacol."},{"key":"ref_17","first-page":"53","article-title":"Examining the Value and Quality of Health Economic Analyses: Implications of Utilizing the QHES","volume":"9","author":"Ofman","year":"2003","journal-title":"J. Manag. Care Pharm."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.puhe.2019.01.012","article-title":"Economic evaluations of public health implementation-interventions: A systematic review and guideline for practice","volume":"169","author":"Reeves","year":"2019","journal-title":"Public Health"},{"key":"ref_19","unstructured":"Drummond, M.F. (2015). Methods for the Economic Evaluation of Health Care Programmes, Oxford Univeristy Press. [4th ed.]."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"164","DOI":"10.3389\/fpubh.2015.00164","article-title":"Economic Evaluation Enhances Public Health Decision Making","volume":"3","author":"Rabarison","year":"2015","journal-title":"Front. Public Health"},{"key":"ref_21","unstructured":"Australian Government (2015). Efficiency in Health in Productivity Commission Research Paper, Australian Government Productivity Commission."},{"key":"ref_22","unstructured":"Hunter New England Local Health District (2018). Welcome to the John Hunter Hospital Birthing Services. Information for Women and Their Families, Hunter New England Local Health District."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: Building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J. Biomed. Inform."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014A metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J. Biomed. Inform."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Husereau, D. (2013). Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. BMJ Br. Med. J., 346.","DOI":"10.1136\/bmj.f1049"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1016\/j.clnu.2013.09.015","article-title":"Reproducibility and comparative validity of a food frequency questionnaire for Australian adults","volume":"33","author":"Collins","year":"2014","journal-title":"Clin. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Ashton, L.M., Williams, R.L., Wood, L.G., Schumacher, T.L., Burrows, T.L., Rollo, M.E., Pezdirc, K.B., Callister, R., and Collins, C.E. (2017). Comparison of Australian Recommended Food Score (ARFS) and Plasma Carotenoid Concentrations: A Validation Study in Adults. Nutrients, 9.","DOI":"10.3390\/nu9080888"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"785","DOI":"10.3390\/nu7020785","article-title":"The Comparative Validity and Reproducibility of a Diet Quality Index for Adults: The Australian Recommended Food Score","volume":"7","author":"Collins","year":"2015","journal-title":"Nutrients"},{"key":"ref_29","unstructured":"Australian Consortium for Classification Development (2020, September 09). AR-DRG. Available online: https:\/\/www.accd.net.au\/ArDrg.aspx."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1038\/s41390-018-0071-3","article-title":"Directed acyclic graphs: A tool for causal studies in paediatrics","volume":"84","author":"Williams","year":"2018","journal-title":"Pediatr. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1146\/annurev-psych-122414-033352","article-title":"Causal Inference in Developmental Origins of Health and Disease (DOHaD) Research","volume":"67","author":"Gage","year":"2016","journal-title":"Annu. Rev. Psychol."},{"key":"ref_32","first-page":"27","article-title":"Thinking Clearly About Correlations and Causation: Graphical Causal Models for Observational Data","volume":"1","author":"Rohrer","year":"2018","journal-title":"Adv. Methods Pr. Psychol. Sci."},{"key":"ref_33","first-page":"1887","article-title":"Robust causal inference using directed acyclic graphs: The R package \u2018dagitty\u2019","volume":"45","author":"Textor","year":"2017","journal-title":"Int. J. Epidemiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1093\/biomet\/80.1.27","article-title":"Bias Reduction of Maximum Likelihood Estimates","volume":"80","author":"Firth","year":"1993","journal-title":"Biometrika"},{"key":"ref_35","unstructured":"Australian Consortium for Classification Development (2014). Review of the AR-DRG Classification Case Complexity Process: Final Report 2014, Prepared for the Independent Hospital Pricing Authority."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"111","DOI":"10.2147\/LRA.S186530","article-title":"Obesity and Obstetric Anesthesia: Current Insights","volume":"12","author":"Taylor","year":"2019","journal-title":"Local Reg. Anesthesia"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"45","DOI":"10.2147\/LRA.S64279","article-title":"Managing anesthesia for cesarean section in obese patients: Current perspectives","volume":"9","author":"Habib","year":"2016","journal-title":"Local Reg. Anesth."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/j.midw.2010.02.010","article-title":"\u2018Not waving but drowning\u2019: A study of the experiences and concerns of midwives and other health professionals caring for obese childbearing women","volume":"27","author":"Schmied","year":"2011","journal-title":"Midwifery"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Slater, K., Rollo, M.E., Szewczyk, Z., Ashton, L.M., Schumacher, T.L., and E Collins, C. (2020). Do the Dietary Intakes of Pregnant Women Attending Public Hospital Antenatal Clinics Align with Australian Guide to Healthy Eating Recommendations?. Nutrients, 12.","DOI":"10.3390\/nu12082438"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11892-020-1288-1","article-title":"Are Lifestyle Interventions to Reduce Excessive Gestational Weight Gain Cost Effective? A Systematic Review","volume":"20","author":"Bailey","year":"2020","journal-title":"Curr. Diabetes Rep."},{"key":"ref_41","first-page":"499","article-title":"Cost Effectiveness of Antenatal Lifestyle Interventions for Preventing Gestational Diabetes and Hypertensive Disease in Pregnancy","volume":"4","author":"Bailey","year":"2020","journal-title":"Pharm. Econ. Open"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1111\/jhn.12550","article-title":"Disparities exist between the dietary intake of Indigenous Australian women during pregnancy and the Australian dietary guidelines: The Gomeroi gaaynggal study","volume":"31","author":"Lee","year":"2018","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1007\/s00404-014-3469-0","article-title":"The effects of maternal age and parity on maternal and neonatal outcome","volume":"291","author":"Schimmel","year":"2014","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_44","first-page":"1235","article-title":"Advanced maternal age increases the risk of very preterm birth, irrespective of parity: A population-based register study","volume":"124","author":"Cnattingius","year":"2016","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"205","DOI":"10.5152\/jtgga.2013.62347","article-title":"The impact of parity on perinatal outcomes in pregnancies complicated by advanced maternal age","volume":"14","author":"Baser","year":"2013","journal-title":"J. Turk. Gynecol. Assoc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1097\/AOG.0000000000002504","article-title":"Risk of adverse pregnancy outcomes at advanced maternal age","volume":"131","author":"Frederiksen","year":"2018","journal-title":"Obstet. Gynecol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-015-0676-z","article-title":"Socio-demographic inequalities across a range of health status indicators and health behaviours among pregnant women in prenatal primary care: A cross-sectional study","volume":"15","author":"Baron","year":"2015","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Boudet-Berquier, J., Salanave, B., Desenclos, J.-C., and Castetbon, K. (2017). Sociodemographic factors and pregnancy outcomes associated with prepregnancy obesity: Effect modification of parity in the nationwide Epifane birth-cohort. BMC Pregnancy Childbirth, 17.","DOI":"10.1186\/s12884-017-1456-8"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2975","DOI":"10.1017\/S1368980016001245","article-title":"Diet quality before or during pregnancy and the relationship with pregnancy and birth outcomes: The Australian Longitudinal Study on Women\u2019s Health","volume":"19","author":"Gresham","year":"2016","journal-title":"Public Health Nutr."},{"key":"ref_50","unstructured":"Australian Institute of Health and Welfare (2017). Australia\u2019s Welfare 2017: in Brief, Australian Government."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1111\/ajo.12591","article-title":"Public-private differences in short-term neonatal outcomes following birth by prelabour caesarean section at early and full term","volume":"57","author":"Adams","year":"2017","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1111\/aogs.12854","article-title":"Inter-hospital variations in labor induction and outcomes for nullipara: An Australian population-based linkage study","volume":"95","author":"Nippita","year":"2016","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"474","DOI":"10.5694\/j.1326-5377.2009.tb02521.x","article-title":"Adverse outcomes of labour in public and private hospitals in Australia: A population-based descriptive study","volume":"190","author":"Robson","year":"2009","journal-title":"Med. J. Aust."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e001723","DOI":"10.1136\/bmjopen-2012-001723","article-title":"Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: A population-based descriptive study","volume":"2","author":"Dahlen","year":"2012","journal-title":"BMJ Open"},{"key":"ref_55","unstructured":"Australian Institute of Health and Welfare (2014). Australia\u2019s Mothers and Babies 2012. Perinatal Statistics Series Number 30, Australian Institute of Health and Welfare."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1097\/AOG.0000000000000679","article-title":"Association of Reported Trimester-Specific Smoking Cessation With Fetal Growth Restriction","volume":"125","author":"Blatt","year":"2015","journal-title":"Obstet. Gynecol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13012-018-0806-x","article-title":"A practice change intervention to improve antenatal care addressing alcohol consumption by women during pregnancy: Research protocol for a randomised stepped-wedge cluster trial","volume":"13","author":"Kingsland","year":"2018","journal-title":"Implement. Sci."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e290","DOI":"10.1016\/S2214-109X(17)30021-9","article-title":"Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: A systematic review and meta-analysis","volume":"5","author":"Popova","year":"2017","journal-title":"Lancet Glob. Health"},{"key":"ref_59","unstructured":"Stanesby, O., Cook, M., and Callinan, S. (2017). Examining Trends in Alcohol Consumption during Pregnancy in Australia, 2001 to 2016, Foundation for Alcohol Research and Education."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s12916-014-0163-9","article-title":"The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on neonatal health outcomes: The LIMIT randomised trial","volume":"12","author":"Dodd","year":"2014","journal-title":"BMC Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e2088","DOI":"10.1136\/bmj.e2088","article-title":"Effects of interventions in pregnancy on maternal weight and obstetric outcomes: Meta-analysis of randomised evidence","volume":"344","author":"Thangaratinam","year":"2012","journal-title":"BMJ"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.jmwh.2005.11.008","article-title":"Maternal Body Mass Index, Delivery Route, and Induction of Labor in a Midwifery Caseload","volume":"51","author":"Graves","year":"2006","journal-title":"J. Midwifery Women\u2019s Health"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1111\/j.1471-0528.2006.01038.x","article-title":"Linear association between maternal pre-pregnancy body mass index and risk of caesarean section in term deliveries","volume":"113","author":"Barau","year":"2006","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_64","unstructured":"(2015). Birth after Previous Caesarean Section, Royal Australian and New Zealand College of Obstetricians and Gynaecologists."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"ACOG Committee on Obstetric Practice, ACOG Committee on Gynecologic Practice, and ACOG Committee on Genetics (2005). ACOG Committee Opinion #324: Perinatal Risks Associated With Assisted Reproductive Technology. Obstet. Gynecol., 106, 1143\u20131146.","DOI":"10.1097\/00006250-200511000-00061"},{"key":"ref_66","unstructured":"The Royal Australian College of General Practitioners (2016). Pregnancy with pre-existing type 2 diabetes. General Practice Management of Type 2 Diabetes: 2016\u201318, The Royal Australian College of General Practitioners."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1111\/j.1467-789X.2007.00464.x","article-title":"Maternal obesity: Pregnancy complications, gestational weight gain and nutrition","volume":"9","author":"Guelinckx","year":"2008","journal-title":"Obes. Rev."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/ajo.12253","article-title":"The SOMANZ Guidelines for the Management of Hypertensive Disorders of Pregnancy 2014","volume":"55","author":"Lowe","year":"2014","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1111\/j.1464-5491.2011.03371.x","article-title":"Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes","volume":"28","author":"Dyson","year":"2011","journal-title":"Diabet. Med."},{"key":"ref_70","unstructured":"National Institute for Health and Care Excellence (2011). Multiple pregnancy: Antenatal care for twin and triplet pregnancies. Clinical Guideline [CG129], NICE."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"F182","DOI":"10.1136\/archdischild-2017-314405","article-title":"Estimating neonatal length of stay for babies born very preterm","volume":"104","author":"Seaton","year":"2018","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"e004017","DOI":"10.1136\/bmjopen-2013-004017","article-title":"Analysis of variation in charges and prices paid for vaginal and caesarean section births: A cross-sectional study","volume":"4","author":"Hsia","year":"2014","journal-title":"BMJ Open"},{"key":"ref_73","unstructured":"(2016). NSW Maternity and Neonatal Service Capability Framework. Guideline, Ministry of Health, NSW."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/12\/11\/3532\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:34:45Z","timestamp":1760178885000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/12\/11\/3532"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,17]]},"references-count":73,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["nu12113532"],"URL":"https:\/\/doi.org\/10.3390\/nu12113532","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,17]]}}}