• S Räisänen, S M Lehto, H S Nielsen, M Gissler, M R Kramer, and S Heinonen.
• Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland.
• BJOG. 2014 Jul 1;121(8):965-70.

ObjectiveTo identify risk factors for fear of childbirth (FOC) according to parity and socioeconomic status, and to evaluate associations between FOC and adverse perinatal outcomes.DesignA cohort study.SettingThe Finnish Medical Birth Register.PopulationAll 788 317 singleton births during 1997-2010 in Finland.MethodsFear of childbirth was defined according to the International Classification of Diseases code O99.80, and its associations with several risk factors and perinatal outcomes were analysed by multivariable logistic regression.Main Outcome MeasuresPrevalence of, risk factors for and outcomes of FOC.ResultsFear of childbirth was experienced by 2.5% of nulliparous women and 4.5% of multiparous women. The strongest risk factors for FOC in nulliparous women were depression [adjusted odds ratio (aOR), 6.35; 95% confidence interval (CI), 5.25-7.68], advanced maternal age (aOR, 3.78; 95% CI, 3.23-4.42) and high or unspecified socioeconomic status. In multiparous women, the strongest risk factors for FOC were depression (aOR, 5.47; 95% CI, 4.67-6.41), previous caesarean section (CS) (aOR, 3.02; 95% CI, 2.93-3.11) and high or unspecified socioeconomic status. Among both nulliparous and multiparous women, FOC was associated with higher rates of CS (3.3-fold and 4.5-fold higher, respectively) and a lower incidence of low birthweight (<2500 g), small for gestational age babies, preterm birth and low Apgar scores at 1 minute.ConclusionsHigh and unspecified socioeconomic status, advanced maternal age and depression are predisposing factors for FOC regardless of parity. Among multiparous women, a previous CS increases vulnerability to FOC. FOC is associated with increased rates of CS, but does not adversely affect other pregnancy outcomes.© 2014 Royal College of Obstetricians and Gynaecologists.

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