ABSTRACT
Background
Fear of childbirth (FoC) adversely affects maternal and neonatal health. This review examined associations between prenatal depression, trait and state anxiety, anxiety sensitivity, and FoC.
Methods
PubMed, Web of Science, Scopus, SID, and Google Scholar were searched until March 20, 2026. Quality was assessed with the Newcastle-Ottawa Scale. Robustness of pooled estimates was assessed through subgroup analyses stratified by study quality and data type (continuous vs. dichotomous FoC), meta-regression examining maternal age, nulliparity, planned pregnancy, and scale type as moderators, sensitivity analyses excluding adjusted effect sizes, and leave-one-out analyses.
Results
From 2136 identified studies, 33 were included. FoC was significantly correlated with depression (r = 0.36, 95% CI 0.27–0.44), trait anxiety (r = 0.35, 95% CI 0.24–0.46), and state anxiety (r = 0.38, 95% CI 0.23–0.52), with moderate certainty. Total anxiety sensitivity (r = 0.29, 95% CI 0.09–0.46) and its physical (r = 0.42), psychological (r = 0.28), and social (r = 0.19) dimensions were also positively associated with FoC, albeit with low certainty. Subgroup analyses based on data type, sensitivity analyses excluding adjusted effect sizes, and meta-regression with scale type as a moderator confirmed the robustness of these associations. Meta-regression did not find significant moderating effects for maternal age, nulliparity, or planned pregnancy; however, these findings should be interpreted with caution due to limited statistical power.
Conclusions
Prenatal depression and trait and state anxiety were associated with the increased risk of FoC, while anxiety sensitivity may also be associated with the increased risk of FoC. Causal inferences cannot be made due to the predominantly cross-sectional design of included studies, and reverse causality or bidirectional associations cannot be excluded.