Fear of childbirth in primiparous Italian pregnant women: The role of anxiety, depression, and couple adjustment Sara Molgora a, *, Valentina Fenaroli a , Laura Elvira Prino b , Luca Rollè b , Cristina Sechi c , Annamaria Trovato d , Laura Vismara c , Barbara Volpi d , Piera Brustia b , Loredana Lucarelli c , Renata Tambelli d , Emanuela Saita a a Catholic University of Milan, Largo Gemelli 1, 20123 Milan, Italy b University of Turin, via Verdi 8, 10124 Turin, Italy c University of Cagliari, via Università 40, 09124 Cagliari, Italy d Sapienza University of Rome, via dei Marsi 78, 00185 Rome, Italy A R T I C L E I N F O Article history: Received 10 October 2016 Received in revised form 19 May 2017 Accepted 22 June 2017 Available online xxx Keywords: Fear of childbirth Severe fear of childbirth Pregnancy Risk factors Primiparous women A B S T R A C T Background: The prevalence of fear of childbirth in pregnant women is described to be about 20–25%, while 6–10% of expectant mothers report a severe fear that impairs their daily activities as well as their ability to cope with labour and childbirth. Research on fear of childbirth risk factors has produced heterogeneous results while being mostly done with expectant mothers from northern Europe, northern America, and Australia. Aims: The present research investigates whether fear of childbirth can be predicted by socio- demographic variables, distressing experiences before pregnancy, medical-obstetric factors and psychological variables with a sample of 426 Italian primiparous pregnant women. Methods: Subjects, recruited between the 34th and 36th week of pregnancy, completed a questionnaire packet that included the Wijma Delivery Expectancy Questionnaire, the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory, the Dyadic Adjustment Scale, the Multidimensional Scale of Perceived Social Support, as well as demographic and anamnestic information. Fear of childbirth was treated as both a continuous and a dichotomous variable, in order to differentiate expectant mothers as with a severe fear of childbirth. Findings: Results demonstrate that anxiety as well as couple adjustment predicted fear of childbirth when treated as a continuous variable, while clinical depression predicted severe fear of childbirth. Conclusions: Findings support the key role of psychological variables in predicting fear of childbirth. Results suggest the importance of differentiating low levels of fear from intense levels of fear in order to promote adequate support interventions. © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved. Statement of significance Problem or issue Although fear of childbirth is a common feeling among pregnant women, severe forms could affect both the mother’s and fetus’s well-being. Identifying fear risk factors helps realize early interventions for expectant mothers. What is already known About 20–25% of pregnant women experience fear of childbirth, and approximately 6–10% report severe fear of childbirth. Severe fear of childbirth can affect an expectant mother’s daily life and impact on their ability to cope with labour and birth. Research has analysed fear risk factors reporting contrasting results. Research has been done largely with North Europe, North America and Australia populations. What this paper adds Fear risk factors are studied in an underrepresented sample of Italian primiparous women. Fear has been considered both as a continuous as well as a dichotomous variable, to * Corresponding author at: Department of Psychology, Catholic University of Milan, Largo Gemelli 1, 20123 Milan, Italy. Fax: +39 0272345962. E-mail address: sara.molgora@unicatt.it (S. Molgora). http://dx.doi.org/10.1016/j.wombi.2017.06.022 1871-5192/© 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved. Women and Birth xxx (2017) xxx–xxx G Model WOMBI 670 No. of Pages 7 Please cite this article in press as: S. Molgora, et al., Fear of childbirth in primiparous Italian pregnant women: The role of anxiety, depression, and couple adjustment, Women Birth (2017), http://dx.doi.org/10.1016/j.wombi.2017.06.022 Contents lists available at ScienceDirect Women and Birth journal homepage: www.elsevier.com/locate/wombi