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We examined the association between CD and childhood overweight at age 6\u00a0years and explored early life body mass index patterns including adiposity rebound (AR), in a large Japanese birth cohort. We analyzed 64,281 singleton mother-child pairs from the Japan Environment and Children\u2019s Study. Overweight at age 6\u00a0years was defined according to the International Obesity Task Force criteria. Logistic regression models were used to estimate adjusted odds ratios (aORs). Changes in overweight status between ages 3 and 6\u00a0years were examined to distinguish incident overweight from persistent overweight, and AR timing was evaluated. CD accounted for 18.5% of the births. Overweight at age 6\u00a0years was more frequent among children born by CD than among those born by vaginal delivery (10.7% vs. 8.8%). After adjusting for the prespecified covariates, CD was associated with higher odds of overweight at age 6\u00a0years (aOR 1.09, 95% confidence interval 1.02\u20131.16). In sex-stratified analyses, CD was associated with incident overweight between ages 3 and 6\u00a0years among females but not among males; however, the interaction between delivery mode and sex was not statistically significant. CD was not significantly associated with earlier AR.<\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusion<\/jats:italic>\n                    : In this large Japanese cohort, CD was modestly associated with childhood overweight at age 6\u00a0years.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Cesarean delivery (CD) is associated with a moderately increased risk for childhood overweight.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Evidence regarding the association between CD and overweight beyond early childhood is limited.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\n                              <jats:italic>In this large Japanese birth cohort, CD was associated with overweight in children aged 6 years.<\/jats:italic>\n                              \u2022\n                              <jats:italic>CD was associated with a higher incidence of new-onset overweight between ages 3 and 6 years only among girls.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  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