{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T21:21:57Z","timestamp":1791667317728,"version":"4.3.4"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Fear of childbirth is a common concern among pregnant women, potentially affecting maternal physical and mental health as well as birth outcomes. However, the factors influencing fear of childbirth are still being explored. This study aims to assess the prevalence of fear of childbirth among women in late pregnancy and identify associated factors, with a particular focus on pregnancy comorbidities, complications, and specific obstetric conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional study was conducted from October 2022 to March 2024 at a tertiary women\u2019s and children\u2019s hospital in western China. A total of 6,335 pregnant women were recruited. The Childbirth Attitude Questionnaire was used to measure fear of childbirth. Data on pregnancy comorbidities, complications, and specific obstetric conditions were extracted from the hospital information system. Ordinal logistic regression was performed to analyze factors associated with different levels of fear of childbirth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean score of the Childbirth Attitude Questionnaire was 34.69\u202f\u00b1\u202f8.15. 79.8% of the participants reported mild to severe fear of childbirth in late pregnancy. Ordinal logistic regression analysis identified several significant risk factors for severe fear of childbirth, including lower education level, primiparity, no history of uterine scarring, natural conception, intention to have a cesarean section, high myopia, and urinary disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Fear of childbirth is highly prevalent among women in late pregnancy and is influenced by multiple factors, including pregnancy comorbidities and complications. Obstetric healthcare providers should be aware of fear of childbirth and consider both sociodemographic and obstetric characteristics when implementing targeted interventions and counseling to support high-risk groups.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1589568","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T05:46:30Z","timestamp":1748583990000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Prevalence and factors associated with fear of childbirth in late pregnancy: a cross-sectional study"],"prefix":"10.3389","volume":"13","author":[{"given":"Dongning","family":"He","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinling","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoyu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingxin","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangxue","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biru","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1186\/s12978-022-01493-9","article-title":"The impact of the COVID-19 pandemic on stress and other psychological factors in pregnant women giving birth during the first wave of the pandemic","volume":"19","author":"H\u00fcbner","year":"2022","journal-title":"Reprod Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s12884-018-1659-7","article-title":"Definitions, measurements and prevalence of fear of childbirth: a systematic review","volume":"18","author":"Nilsson","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"100593","DOI":"10.1016\/j.srhc.2020.100593","article-title":"Prenatal fear of childbirth among pregnant women and their spouses in Kenya","volume":"27","author":"Onchonga","year":"2021","journal-title":"Sex Reprod Healthc"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1111\/aogs.13138","article-title":"Worldwide prevalence of tocophobia in pregnant women: systematic review and meta-analysis","volume":"96","author":"O'Connell","year":"2017","journal-title":"Acta Obstet Gynecol Scand"},{"key":"ref5","doi-asserted-by":"crossref","DOI":"10.1111\/jan.16636","article-title":"The trajectory and influencing factors of fear of childbirth in third trimester primiparas: a prospective longitudinal study","volume-title":"J Adv Nurs","author":"Ji","year":"2024"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e242","DOI":"10.1016\/j.wombi.2017.02.003","article-title":"Presence and process of fear of birth during pregnancy-findings from a longitudinal cohort study","volume":"30","author":"Hildingsson","year":"2017","journal-title":"Women Birth"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"9319","DOI":"10.1038\/s41598-024-58855-5","article-title":"Fear of childbirth and its associated factors among pregnant women in Dejen Woreda, east Gojjam zone, Northwest Ethiopia: a community-based cross-sectional study","volume":"14","author":"Alemu","year":"2024","journal-title":"Sci Rep"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"297","DOI":"10.3390\/healthcare11030297","article-title":"Antenatal fear of childbirth as a risk factor for a bad childbirth experience","volume":"11","author":"R\u00fager-Navarrete","year":"2023","journal-title":"Healthcare (Basel)"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"CD005528","DOI":"10.1002\/14651858.CD005528.pub3","article-title":"Non-clinical interventions for reducing unnecessary caesarean section","volume":"2018","author":"Chen","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1007\/s00404-014-3532-x","article-title":"Personality, fear of childbirth and birth outcomes in nulliparous women","volume":"291","author":"Handelzalts","year":"2015","journal-title":"Arch Gynecol Obstet"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1111\/birt.12349","article-title":"Labor pain in women with and without severe fear of childbirth: a population-based, longitudinal study","volume":"45","author":"Junge","year":"2018","journal-title":"Birth"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1007\/s00737-022-01212-0","article-title":"The influence of maternal psychological distress on the mode of birth and duration of labor: findings from the FinnBrain birth cohort study","volume":"25","author":"Sanni","year":"2022","journal-title":"Arch Womens Ment Health"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.1111\/j.1471-0528.2012.03433.x","article-title":"Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery","volume":"119","author":"Adams","year":"2012","journal-title":"BJOG"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"100143","DOI":"10.1016\/j.eurox.2022.100143","article-title":"Relationship between Primigravid women's awareness, attitude, fear of childbirth, and mode of delivery preference","volume":"14","author":"Khosravi","year":"2022","journal-title":"Eur J Obstet Gynecol Reprod Biol X"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1002\/ijgo.14781","article-title":"Fear of childbirth and use of labor analgesia: a nationwide register-based analysis in Finland","volume":"162","author":"Vaajala","year":"2023","journal-title":"Int J Gynaecol Obstet"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1221133","DOI":"10.3389\/fpsyg.2023.1221133","article-title":"Mode of delivery preferences: the role of childbirth fear among nulliparous women","volume":"14","author":"Elgzar","year":"2023","journal-title":"Front Psychol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/j.apnr.2016.07.013","article-title":"The effects of antenatal education on fear of childbirth, maternal self-efficacy and post-traumatic stress disorder (PTSD) symptoms following childbirth: an experimental study","volume":"32","author":"G\u00f6k\u00e7e \u0130sbir","year":"2016","journal-title":"Appl Nurs Res"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.jad.2023.11.054","article-title":"The impact of fear of childbirth on mode of delivery, postpartum mental health and breastfeeding: a prospective cohort study in Shanghai, China","volume":"347","author":"Yin","year":"2024","journal-title":"J Affect Disord"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1448940","DOI":"10.3389\/fpubh.2024.1448940","article-title":"Factors influencing childbirth fear among Asian women: a scoping review","volume":"12","author":"Kalok","year":"2024","journal-title":"Front Public Health"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1186\/s12888-023-05070-7","article-title":"Fear of childbirth and its determinants in pregnant women in the third trimester: a cross-sectional study","volume":"23","author":"Zhang","year":"2023","journal-title":"BMC Psychiatry"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1159\/000299490","article-title":"Identification of women with significant fear of childbirth during late pregnancy","volume":"13","author":"Areskog","year":"1982","journal-title":"Gynecol Obstet Investig"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"219","DOI":"10.3109\/01674820009085591","article-title":"Self-efficacy for labor and childbirth fears in nulliparous pregnant women","volume":"21","author":"Lowe","year":"2000","journal-title":"J Psychosom Obstet Gynaecol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1111\/j.1365-2648.2010.05479.x","article-title":"Childbirth self-efficacy inventory and childbirth attitudes questionnaire: psychometric properties of Thai language versions","volume":"67","author":"Tanglakmankhong","year":"2011","journal-title":"J Adv Nurs"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"81","DOI":"10.3870\/j.issn.1001-4152.2016.02.081","article-title":"Reliability and validity of the Chinese version of childbirth attitudes questionnaire [in Chinese]","volume":"31","author":"Wei","year":"2016","journal-title":"J Nurs Sci"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1186\/s12884-021-04123-7","article-title":"The prevalence and predictors of fear of childbirth among pregnant Chinese women: a hierarchical regression analysis","volume":"21","author":"Huang","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e136","DOI":"10.1016\/j.wombi.2019.04.005","article-title":"Fear of childbirth in nulliparous women: a cross-sectional multicentre study in China","volume":"33","author":"Qiu","year":"2020","journal-title":"Women Birth"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"731","DOI":"10.2147\/PRBM.S309889","article-title":"Fear of childbirth and associated risk factors in healthy pregnant women in northwest of China: a cross-sectional study","volume":"14","author":"Zhou","year":"2021","journal-title":"Psychol Res Behav Manag"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1111\/1471-0528.12599","article-title":"Fear of childbirth in nulliparous and multiparous women: a population-based analysis of all singleton births in Finland in 1997-2010","volume":"121","author":"R\u00e4is\u00e4nen","year":"2014","journal-title":"BJOG"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1111\/j.1471-0528.2008.02002.x","article-title":"Fear of childbirth according to parity, gestational age, and obstetric history","volume":"116","author":"Rouhe","year":"2009","journal-title":"BJOG"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e44","DOI":"10.1016\/j.wombi.2015.02.004","article-title":"Validation of the childbirth attitudes questionnaire in Greek and psychosocial characteristics of pregnant women with fear of childbirth","volume":"28","author":"Gourounti","year":"2015","journal-title":"Women Birth"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1111\/ppc.12900","article-title":"Psychosocial predictors of mental health among pregnant women","volume":"58","author":"Shahid","year":"2022","journal-title":"Perspect Psychiatr Care"},{"key":"ref32","first-page":"768","article-title":"Study on the current situation and influencing factors of pregnant women's fear of childbirth in late pregnancy [in Chinese]","volume":"20","author":"Hu","year":"2020","journal-title":"J Nurs Adm"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"3733","DOI":"10.19082\/3733","article-title":"The role of fear of childbirth in pregnancy related anxiety in Iranian women: a qualitative research","volume":"9","author":"Arfaie","year":"2017","journal-title":"Electron Physician"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"104088","DOI":"10.1016\/j.midw.2024.104088","article-title":"Prevalence and determinants of fear of childbirth among pregnant women in Egypt: a cross-sectional study","volume":"136","author":"Elsharkawy","year":"2024","journal-title":"Midwifery"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1111\/aogs.14718","article-title":"Fear of childbirth after induced abortion in primiparous women: population-based register study from Finland","volume":"103","author":"Kemppainen","year":"2024","journal-title":"Acta Obstet Gynecol Scand"},{"key":"ref36","doi-asserted-by":"crossref","DOI":"10.1097\/JPN.0000000000000844","article-title":"Comparison of state-trait anxiety and fear of childbirth according to attachment styles of pregnant women","volume-title":"J Perinat Neonatal Nurs","author":"Y\u0131ld\u0131r\u0131m","year":"2024"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1186\/s12884-023-05948-0","article-title":"Fear of childbirth: prevalence and associated factors in pregnant women of a maternity hospital in southern Brazil","volume":"23","author":"Dal Moro","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1016\/j.midw.2015.05.003","article-title":"Predictors of childbirth fear among pregnant Chinese women: a cross-sectional questionnaire survey","volume":"31","author":"Gao","year":"2015","journal-title":"Midwifery"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1111\/j.1471-0528.2007.01583.x","article-title":"Fear of childbirth: predictors and temporal changes among nulliparous women in the Danish National Birth Cohort","volume":"115","author":"Laursen","year":"2008","journal-title":"BJOG"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e68267","DOI":"10.7759\/cureus.68267","article-title":"Health literacy levels of women attending a perinatology outpatient Clinic for High-Risk Pregnancy Follow-up","volume":"16","author":"Albayrak","year":"2024","journal-title":"Cureus"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1177\/0272684X221095659","article-title":"Maternal health literacy, health information-seeking behavior and pregnancy outcomes among Iranian pregnant women: a cross-sectional study","volume":"44","author":"Sabetghadam","year":"2023","journal-title":"Community Health Equity Res Policy"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1186\/s12884-018-2023-7","article-title":"Childbirth fear and related factors among pregnant and postpartum women in Malawi","volume":"18","author":"Khwepeya","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1111\/nhs.12571","article-title":"Qualitative exploration of fear of childbirth and preferences for mode of birth among Japanese primiparas","volume":"20","author":"Takegata","year":"2018","journal-title":"Nurs Health Sci"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"99","DOI":"10.3109\/0167482x.2012.685905","article-title":"No relationship between fear of childbirth and pregnancy\u2212\/delivery-outcome in a low-risk Dutch pregnancy cohort delivering at home or in hospital","volume":"33","author":"Sluijs","year":"2012","journal-title":"J Psychosom Obstet Gynaecol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1186\/s12884-022-04721-z","article-title":"Fear of childbirth and its predictors in re-pregnant women after cesarean section: a cross-sectional multicenter study in China","volume":"22","author":"Hou","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1080\/01443615.2019.1584885","article-title":"Fear of childbirth and associated factors among low-risk pregnant women","volume":"39","author":"Phunyammalee","year":"2019","journal-title":"J Obstet Gynaecol"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1186\/s12884-015-0655-4","article-title":"Fear of childbirth and elective caesarean section: a population-based study","volume":"15","author":"St\u00f8rksen","year":"2015","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1016\/j.midw.2010.05.004","article-title":"Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample","volume":"27","author":"Haines","year":"2011","journal-title":"Midwifery"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"55","DOI":"10.4103\/jehp.jehp_150_17","article-title":"Factors involved in selecting the birth type among primiparous women","volume":"7","author":"Safari-Moradabadi","year":"2018","journal-title":"J Educ Health Promot"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"130","DOI":"10.4103\/jehp.jehp_4_19","article-title":"The relationship between attitude toward labor pain and length of the first, second, and third stages in primigravida women","volume":"8","author":"Beigi","year":"2019","journal-title":"J Educ Health Promot"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1034\/j.1600-0412.2003.00114.x","article-title":"Fear of childbirth: a neglected dilemma","volume":"82","author":"Saisto","year":"2003","journal-title":"Acta Obstet Gynecol Scand"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"217","DOI":"10.17772\/gp\/61752","article-title":"Cesarean section and eye disorders","volume":"87","author":"Karska-Basta","year":"2016","journal-title":"Ginekol Pol"},{"key":"ref53","article-title":"Significant kidney disease in pregnancy: feasibility and outcomes of a national population-based study using the Australasian maternity outcomes surveillance system","volume-title":"Aust N Z J Obstet Gynaecol","author":"Jesudason","year":"2024"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"625","DOI":"10.62641\/aep.v52i5.1644","article-title":"The adverse effects of anxiety and depression on pregnant women with hypothyroidism in late pregnancy","volume":"52","author":"Ma","year":"2024","journal-title":"Actas Esp Psiquiatr"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1589568\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T05:46:32Z","timestamp":1748583992000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1589568\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,30]]},"references-count":54,"alternative-id":["10.3389\/fpubh.2025.1589568"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1589568","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,30]]},"article-number":"1589568"}}