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Yet, little is known about the underlying mechanisms. The objective of this study was therefore to evaluate how mediators contribute to the association between obesity and prelabor\/intrapartum cesarean birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed Swiss cohort data from 394,812 singleton, cephalic deliveries between 2005 and 2020. Obesity (BMI \u2265 30\u2009kg\/m<jats:sup>2<\/jats:sup>) was defined as the exposure and prelabor or intrapartum cesarean birth as the outcomes. Hypothesized mediators included gestational comorbidities, large\u2010for\u2010gestational\u2010age infant, pregnancy duration &gt;41<jats:sup>0\/7<\/jats:sup> weeks, slower labor progress, labor induction, and history of cesarean birth. We performed path analyses using generalized structural equation modeling and assessed mediation by a counterfactual approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Women with obesity had a cesarean birth rate of 39.36% vs. 24.12% in women without obesity. The path models mainly showed positive direct and indirect associations between obesity and cesarean birth. In the total sample, the mediation models explained up to 39.47% (95% CI 36.92\u201342.02) of the association between obesity and cesarean birth, and up to 57.13% (95% CI 54.10\u201360.16) when including history of cesarean birth as mediator in multiparous women. Slower labor progress and history of cesarean birth were found to be the most clinically significant mediators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study provides empirical insights into how obesity may increase cesarean birth rates through mediating processes. Particularly allowing for a slower labor progress in women with obesity might reduce cesarean birth rates and prevent subsequent repeat cesarean births in multiparous women.<\/jats:p><\/jats:sec>","DOI":"10.1111\/birt.12751","type":"journal-article","created":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T06:30:09Z","timestamp":1692945009000},"page":"52-62","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Mediating processes underlying the associations between maternal obesity and the likelihood of cesarean birth"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2384-8114","authenticated-orcid":false,"given":"Carmen","family":"Wyss","sequence":"first","affiliation":[{"name":"Applied Research and Development, Division of Midwifery, Department of Health Professions Bern University of Applied Sciences  Bern Switzerland"},{"name":"Graduate School for Health Sciences University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7884-3222","authenticated-orcid":false,"given":"Jennifer","family":"Inauen","sequence":"additional","affiliation":[{"name":"Department of Health Psychology and Behavioral Medicine, Institute of Psychology University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6773-4015","authenticated-orcid":false,"given":"Eva","family":"Cignacco","sequence":"additional","affiliation":[{"name":"Applied Research and Development, Division of Midwifery, Department of Health Professions Bern University of Applied Sciences  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3957-3810","authenticated-orcid":false,"given":"Luigi","family":"Raio","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University Hospital of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3861-0694","authenticated-orcid":false,"given":"Evelyne M.","family":"Aubry","sequence":"additional","affiliation":[{"name":"Applied Research and Development, Division of Midwifery, Department of Health Professions Bern University of Applied Sciences  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,24]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2019.100041"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j4511"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/obr.12288"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jmwh.12073"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2012.745506"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(18)31930-5"},{"key":"e_1_2_9_8_1","unstructured":"Swiss Federal Statistical Office.Reproductive Health.2021.https:\/\/www.bfs.admin.ch\/bfs\/en\/home\/statistics\/health\/state\u2010health\/reproductive\u2010health.html"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-015-0043-6"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.13334"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1330-7466"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2018.06.006"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2008.00860.x"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwaa135"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12387"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2012.12.013"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cytogfr.2017.01.001"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12958-015-0129-6"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.08.002"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogoh.2020.101909"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2017.1285894"},{"key":"e_1_2_9_22_1","unstructured":"Association of the Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.).2020. 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