Abstract：
Fear of childbirth can develop due to the concerns or adverse maternal or foetal outcomes experienced in a previous pregnancy. The aim of this study was to examine the main risk factors associated with the development of fear of childbirth during subsequent pregnancies and deliveries.
In this case-control study, data from the National Medical Birth Register were used to evaluate the events in previous pregnancies that were potential risk factors for fear of childbirth in subsequent pregnancies. The first and second pregnancies of women registered during our study period (2004-2018) were included. The exposure variable was delivery mode, obstetric challenge or adverse neonatal outcomes during the first pregnancy. The outcome was the development of FOC during the second pregnancy. Adjusted odds ratios with 95% CIs were used for comparison.
A total of 13 064 pregnancies were included in the case group and 195 351 in the control group. Previous emergency caesarean section was the strongest risk factor for the development of FOC in the second pregnancy (adjusted odds ratio 5.27, CIs 4.83-5.75). In addition, unplanned CS (adjusted odds ratio 3.93, CIs 3.77-4.10) and vacuum delivery (adjusted odds ratio 1.69, CIs 1.61-1.77) also increased the odds of fear of childbirth. Of the obstetric complications, third- or fourth-degree tear of the perineum was the strongest risk factor (adjusted odds ratio 2.99, CIs 2.69-3.31), followed by shoulder dystocia (adjusted odds ratio 2.82, CIs 2.16-3.62). Neonatal mortality also increased the odds for the development of FOC (adjusted odds ratio 2.17, CIs 1.77-2.64).
The main risk factors for the development of fear of childbirth in the second pregnancy were previous fear of childbirth, unplanned CS, vacuum delivery, perineal tear or shoulder dystocia. The results of this study can be used in a clinical setting to improve the prevention of fear of childbirth.
In this case-control study, data from the National Medical Birth Register were used to evaluate the events in previous pregnancies that were potential risk factors for fear of childbirth in subsequent pregnancies. The first and second pregnancies of women registered during our study period (2004-2018) were included. The exposure variable was delivery mode, obstetric challenge or adverse neonatal outcomes during the first pregnancy. The outcome was the development of FOC during the second pregnancy. Adjusted odds ratios with 95% CIs were used for comparison.
A total of 13 064 pregnancies were included in the case group and 195 351 in the control group. Previous emergency caesarean section was the strongest risk factor for the development of FOC in the second pregnancy (adjusted odds ratio 5.27, CIs 4.83-5.75). In addition, unplanned CS (adjusted odds ratio 3.93, CIs 3.77-4.10) and vacuum delivery (adjusted odds ratio 1.69, CIs 1.61-1.77) also increased the odds of fear of childbirth. Of the obstetric complications, third- or fourth-degree tear of the perineum was the strongest risk factor (adjusted odds ratio 2.99, CIs 2.69-3.31), followed by shoulder dystocia (adjusted odds ratio 2.82, CIs 2.16-3.62). Neonatal mortality also increased the odds for the development of FOC (adjusted odds ratio 2.17, CIs 1.77-2.64).
The main risk factors for the development of fear of childbirth in the second pregnancy were previous fear of childbirth, unplanned CS, vacuum delivery, perineal tear or shoulder dystocia. The results of this study can be used in a clinical setting to improve the prevention of fear of childbirth.
摘要：
背景：对分娩的恐惧可能是由于先前妊娠中经历的担忧或不良的母体或胎儿结局而产生的。这项研究的目的是研究与随后的怀孕和分娩期间对分娩的恐惧发展相关的主要危险因素。
方法：在本病例对照研究中，来自国家医学出生登记册的数据用于评估先前妊娠中的事件,这些事件是后续妊娠中担心分娩的潜在危险因素.包括在我们研究期间（2004-2018年）登记的妇女的第一次和第二次怀孕。暴露变量是交付模式，首次妊娠期间的产科挑战或不良新生儿结局。结果是第二次怀孕期间FOC的发展。使用95%CI的调整后优势比进行比较。
结果：病例组共妊娠13.064例，对照组共妊娠195.351例。先前的紧急剖宫产是第二次妊娠发生FOC的最大危险因素（调整后的比值比5.27，CI=4.83-5.75）。此外,计划外CS(调整后比值比3.93,CI=3.77-4.10)和真空分娩(调整后比值比1.69,CI=1.61-1.77)也增加了对分娩的恐惧几率.在产科并发症中，会阴的三或四度撕裂是最强的危险因素（调整后的比值比2.99，CI=2.69-3.31），其次是肩难产(调整后比值比2.82，CI=2.16-3.62)。新生儿死亡率也增加了FOC发展的几率（调整后的比值比2.17，CI=1.77-2.64）。
结论：在第二次怀孕中产生对分娩恐惧的主要危险因素是先前对分娩的恐惧，计划外CS,真空输送,会阴撕裂或肩难产。这项研究的结果可用于临床，以改善对分娩恐惧的预防。
方法：在本病例对照研究中，来自国家医学出生登记册的数据用于评估先前妊娠中的事件,这些事件是后续妊娠中担心分娩的潜在危险因素.包括在我们研究期间（2004-2018年）登记的妇女的第一次和第二次怀孕。暴露变量是交付模式，首次妊娠期间的产科挑战或不良新生儿结局。结果是第二次怀孕期间FOC的发展。使用95%CI的调整后优势比进行比较。
结果：病例组共妊娠13.064例，对照组共妊娠195.351例。先前的紧急剖宫产是第二次妊娠发生FOC的最大危险因素（调整后的比值比5.27，CI=4.83-5.75）。此外,计划外CS(调整后比值比3.93,CI=3.77-4.10)和真空分娩(调整后比值比1.69,CI=1.61-1.77)也增加了对分娩的恐惧几率.在产科并发症中，会阴的三或四度撕裂是最强的危险因素（调整后的比值比2.99，CI=2.69-3.31），其次是肩难产(调整后比值比2.82，CI=2.16-3.62)。新生儿死亡率也增加了FOC发展的几率（调整后的比值比2.17，CI=1.77-2.64）。
结论：在第二次怀孕中产生对分娩恐惧的主要危险因素是先前对分娩的恐惧，计划外CS,真空输送,会阴撕裂或肩难产。这项研究的结果可用于临床，以改善对分娩恐惧的预防。
