Violence during pregnancy amplifies fear of childbirth: A nationwide cohort study in Finland

OBJECTIVE: This study examined the association between fear of childbirth (FOC) and exposure to violence during pregnancy, identified using diagnoses based on the International Classification of Diseases, 10th Revision. METHODS: This population-based cohort study included 1 177 569 births in Finland between 2000 and 2020. Data from the Finnish Medical Birth Register and the Hospital Discharge Register were used to identify women diagnosed with FOC and exposure to violence. Logistic regression analyses were conducted to estimate crude and adjusted odds ratios (ORs) with confidence intervals (CIs), adjusting for major sociodemographic and clinical factors. RESULTS: Fear of childbirth was diagnosed in 23 246 women (2.0%), while 1 154 323 women (98.0%) had no diagnosis of FOC. Women with FOC had a higher prevalence of exposure to violence (0.9%) compared with women without FOC (0.3%). The association remained strong after adjustment for confounders (adjusted OR 3.07; 95% CI 2.66-3.54). A higher prevalence of FOC was observed among parous compared to nulliparous women, divorced women, students, and women experiencing long-term unemployment. CONCLUSION: Women with FOC were substantially more likely to have been exposed to violence. Recognizing FOC as a potential marker of underlying vulnerability might facilitate earlier identification, timely referral, and more responsive psychological and obstetric care.