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Adjusted path analysis logistic regression models were used to assess the role of pre-pregnancy obesity as a mediator in the association between maternal place of birth and the development of severe pre-eclampsia. We calculated 1. adjusted odds ratios and 95% confidence intervals for the total exposure-outcome association and for the direct and indirect\/obesity-mediated components 2. the indirect\/obesity-mediated effect. Ninety-five (0.99%) women developed severe pre-eclampsia, 47.6% were non-European immigrants, 16.3% were born in Sub-Saharan Africa, and 12.6% were obese (BMI\u2009&gt;\u2009=\u200930\u2009kg\/m<jats:sup>2<\/jats:sup>). Women experiencing severe pre-eclampsia were more likely to be from Sub-Saharan Africa (p\u2009=\u20090.023) and be obese (p\u2009=\u20090.048). Mothers from Sub-Saharan Africa had an increased risk of severe pre-eclampsia compared to European-born mothers (aOR 2.53, 95% CI 1.39\u20134.58) and the obesity-mediated indirect effect was 18% of the total risk (aOR 1.18, 95%CI 1.03\u20131.35). In conclusion, Sub-Saharan African immigrant women have a two-fold higher risk of developing severe pre-eclampsia as compared to European-born women, one-fifth of which is mediated by pre-pregnancy obesity. Our results quantify the potential benefit of decreasing obesity among at-risk women.<\/jats:p>","DOI":"10.1038\/s41598-020-62032-9","type":"journal-article","created":{"date-parts":[[2020,3,23]],"date-time":"2020-03-23T11:03:40Z","timestamp":1584961420000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Maternal obesity and severe pre-eclampsia among immigrant women: a mediation analysis"],"prefix":"10.1038","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7457-6745","authenticated-orcid":false,"given":"Ayesha","family":"Siddiqui","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Deneux-Tharaux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Luton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Schmitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Mandelbrot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candice","family":"Estellat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Howell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babak","family":"Khoshnood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Bertille","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elie","family":"Azria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,3,23]]},"reference":[{"key":"62032_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejogrb.2013.05.005","volume":"170","author":"E Abalos","year":"2013","unstructured":"Abalos, E., Cuesta, C., Grosso, A. 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