Update on the Global Prevalence of Severe Fear of Childbirth in Low-Risk Pregnant Women: A Systematic Review and Meta-Analysis

Objectives: Severe fear of childbirth (FOC) has adverse consequences for mother and child. This study aimed to update the global prevalence of severe FOC in low-risk pregnant women. Materials and Methods: Observational studies published in English were obtained through PubMed, Scopus, Science Direct, Wiley Online, and Google Scholar databases up to April 2020. After reviewing the title and introduction, the quality of the articles that had full text and met the inclusion criteria of the study was checked with the JBI checklist. Then, the final extracted data were entered into the STATA software. The overall prevalence of severe FOC and fear in subgroups were obtained using meta-analysis. Tests of publication bias and sensitivity analysis were also performed. Results: Overall, 27 observational studies were included (26014 participants). The global prevalence of severe FOC was 16% (95% CI: 14%–19%). The subgroup analysis showed that after 2015, the prevalence of fear was higher than before (%18 versus %14). The results also showed a higher prevalence of fear in women with a diploma and lower compared to women with a university education (%19 versus %13), in single/divorced women compared to married/cohabitation women (%21 versus %15), in nulliparous women compared to multiparous women (%17 versus %14) and in women experiencing the second trimester of pregnancy compared to women in the third trimester of pregnancy (%23 versus %14). Conclusions: The global prevalence of severe FOC was 16%. Diagnostic, preventive, therapeutic and follow-up strategies are needed to reduce fear in all countries.