Association Between Intolerance of Uncertainty and Coping Behaviours Among Pregnant Women With Fear of Childbirth: A Cross‐Sectional Study

AIMS: This study aimed to explore the associations among intolerance of uncertainty, childbirth self-efficacy, fear of childbirth, and coping styles among primiparous women. DESIGN: A cross-sectional study. METHODS: This study performed subgroup analysis based on a parent cohort of 532 primiparous women established from October 2022 to November 2023. A total of 294 pregnant women with fear of childbirth were selected from this cohort as participants. Participants completed the Childbirth Attitude Questionnaire (CAQ), Revised Prenatal Coping Inventory (NuPCI), Intolerance of Uncertainty Scale-9 (IUS-9), Childbirth Self-Efficacy Inventory (CBSEI-C32), and a sociodemographic data sheet. Kruskal-Wallis tests and Mann-Whitney U tests were used to analyse differences in prenatal coping scores across demographic characteristics. Spearman correlation analysis was used to examine the relationships among fear of childbirth, intolerance of uncertainty, childbirth self-efficacy, and prenatal coping. Finally, Mplus 8.3 was used to test the mediating roles of fear of childbirth and childbirth self-efficacy in the relationship between intolerance of uncertainty and prenatal coping. RESULTS: Structural equation modelling showed that intolerance of uncertainty was positively associated with avoidance coping (B = 0.202, β = 0.228, 95% CI [0.068, 0.355]), with fear of childbirth mediating the relationship between intolerance of uncertainty and avoidance coping (B = 0.186, β = 0.210, 95% CI [0.132, 0.314]). Intolerance of uncertainty was not directly associated with planning-preparation coping but was indirectly negatively associated with planning-preparation coping through fear of childbirth and childbirth self-efficacy (B = -0.042, β = -0.040, 95% CI [-0.093, -0.014]). Intolerance of uncertainty was not directly associated with spiritual-positive coping but was indirectly positively associated with spiritual-positive coping through fear of childbirth (B = 0.033, β = 0.088, 95% CI [0.009, 0.181]). CONCLUSIONS: No direct association was observed between intolerance of uncertainty and either planning-preparation coping or spiritual -positive coping among pregnant women with fear of childbirth. Pregnant women with higher levels of intolerance of uncertainty exhibited more severe fear of childbirth and greater use of avoidance coping and spiritual-positive coping. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses should focus on the perception of uncertainty regarding childbirth and the coping behaviours adopted by pregnant women with fear of childbirth, assess their cognition about childbirth, and guide them to view childbirth positively, thereby reducing fear of childbirth and enhancing their coping ability for childbirth. REPORTING METHOD: This study adheres to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cross-sectional studies. PATIENT OR PUBLIC CONTRIBUTION: Pregnant women were surveyed to collect relevant data.