Global prevalence and associated factors of severe fear of childbirth: a systematic review and Meta-Analysis.
Fear of childbirth (FoC), particularly its severe form (tokophobia), is a significant public health concern associated with adverse maternal and neonatal outcomes. While previous meta-analyses have provided global prevalence estimates, significant knowledge gaps remain due to limited studies. This study aimed to provide an updated global prevalence estimate of severe FoC and explore sources of heterogeneity and associated risk factors.
A systematic review and meta-analysis was conducted following PRISMA and MOOSE guidelines. We searched international and Persian databases from inception until June 2025 for cross-sectional and cohort studies reporting severe FoC prevalence in pregnant women using validated tools with defined cutoffs. Two reviewers independently performed data extraction and quality assessment using the Newcastle-Ottawa Scale. Random-effects models were used for meta-analysis, with heterogeneity assessed via I² statistic. Subgroup analyses and meta-regressions explored variation sources. Risk factors were synthesized descriptively, though nulliparity and unplanned pregnancy allowed meta-analysis.
From 67 included studies (n = 905,504 participants), the pooled prevalence of severe FoC was 16.5% (95% CI: 13.8-19.5%), with significant heterogeneity (I² = 99.45%). Assessment tools and cutoffs were major heterogeneity sources (p < 0.001), with prevalence ranging from 3.7% to 58.7%. Country of study was also a significant moderator (p < 0.001). Meta-regression showed no significant association with maternal age, gestational age, nulliparity percentage, or publication year. Key risk factors included previous traumatic birth, anxiety/depression symptoms, and inadequate social support. Nulliparous women had higher odds of severe FoC (OR = 1.36, 95% CI: 1.04-1.76), as did those with unplanned pregnancy (OR = 1.85, 95% CI: 1.29-2.65).
Severe FoC affects approximately one in six women globally. The substantial heterogeneity, largely due to methodological variations, underscores the need for standardized assessment protocols. Identified associations with factors such as previous traumatic birth and anxiety highlight the condition's multifactorial nature, emphasizing the importance of targeted screening and evidence-based interventions aligned with Sustainable Development Goal (SDG) 3 to improve maternal mental health.
A systematic review and meta-analysis was conducted following PRISMA and MOOSE guidelines. We searched international and Persian databases from inception until June 2025 for cross-sectional and cohort studies reporting severe FoC prevalence in pregnant women using validated tools with defined cutoffs. Two reviewers independently performed data extraction and quality assessment using the Newcastle-Ottawa Scale. Random-effects models were used for meta-analysis, with heterogeneity assessed via I² statistic. Subgroup analyses and meta-regressions explored variation sources. Risk factors were synthesized descriptively, though nulliparity and unplanned pregnancy allowed meta-analysis.
From 67 included studies (n = 905,504 participants), the pooled prevalence of severe FoC was 16.5% (95% CI: 13.8-19.5%), with significant heterogeneity (I² = 99.45%). Assessment tools and cutoffs were major heterogeneity sources (p < 0.001), with prevalence ranging from 3.7% to 58.7%. Country of study was also a significant moderator (p < 0.001). Meta-regression showed no significant association with maternal age, gestational age, nulliparity percentage, or publication year. Key risk factors included previous traumatic birth, anxiety/depression symptoms, and inadequate social support. Nulliparous women had higher odds of severe FoC (OR = 1.36, 95% CI: 1.04-1.76), as did those with unplanned pregnancy (OR = 1.85, 95% CI: 1.29-2.65).
Severe FoC affects approximately one in six women globally. The substantial heterogeneity, largely due to methodological variations, underscores the need for standardized assessment protocols. Identified associations with factors such as previous traumatic birth and anxiety highlight the condition's multifactorial nature, emphasizing the importance of targeted screening and evidence-based interventions aligned with Sustainable Development Goal (SDG) 3 to improve maternal mental health.
Authors
Maghalian Maghalian, Alizadeh-Dibazari Alizadeh-Dibazari, Mirghafourvand Mirghafourvand
View on Pubmed