PROJECT SUMMARY Obesity, the most common medical condition among women of reproductive age, increases maternal-fetal risks that may prompt specialized obstetric intervention. A key decision is whether and when to initiate delivery, often by inducing labor before its spontaneous onset (i.e., induction of labor, IOL). While IOL planning should follow principles of shared decision-making (SDM) – centering women's values and preferences for different birth outcomes in choices for delivery mode and timing – multiple evidentiary gaps impede SDM for IOL with obesity. Perinatal risks of obesity compound the complexity of IOL counseling and decision-making and, in addition to biological risks, weight stigma and bias challenge quality of care and birth experience. Moreover, Black women have higher rates of maternal obesity than White women, and Black women with obesity have the highest rates of IOL. Given the maternal health crisis among Black women in the US, a patient-centered approach is essential. Growing literature suggests that weight bias may contribute to the overuse of interventions including IOL. Further, women with obesity often describe obstetric care as depersonalized and overly focused on weight. Experts urge shifting away from weight-centric care paradigms and toward the AHRQ-stated goal of whole-person, 360- degree care. The proposed project will address critical research and practice gaps by discovering new approaches to obesity phenotyping tied to individualized care models for racially and ethnically diverse patients. Aim 1 will empirically derive maternal obesity phenotypes using latent class analysis and evaluate subtype associations with pregnancy outcomes in data from 9000 racially, ethnically, and geographically diverse nulliparous women. Aim 3 will use these phenotypes in Aim 2 interviews with clinicians to elicit contextual barriers and facilitators to SDM with diverse patient profiles and organize themes along AHRQ's SHARE SDM framework. Aim 3 will adapt an existing IOL patient decision aid (PDA) to the obesity context and pair the PDA with implementation strategies, informed by Aim 2 interviews, to overcome barriers to use. The mentor/advisor team will function as an “Implementation Team” to incorporate findings into a SDM toolkit through iterative workshops. Building on the applicant's background in perinatal epidemiology, qualitative research methods, and health care quality and equity, the proposed training program of formal coursework, mentoring, and professional development will build expertise in (1) latent class and cluster analysis, 2) shared decision-making, and (3) implementation science. The collective research and training will generate preliminary data and culminate in the submission of an R01 proposal for an equity-focused implementation-effectiveness trial on SDM adherence, decision quality, patient experience, and perinatal outcomes. The proposed K01 Mentored Research Scientist Career Development Award will estab...