Maternal Psychological Responses During Regional War: A Cross-Sectional Study of Fear of Childbirth, Stress, and Intolerance of Uncertainty

Objective: Armed conflict may intensify psychological vulnerability during pregnancy. This cross-sectional study examined associations of perceived stress and intolerance of uncertainty during wartime, with fear of childbirth and maternal outcomes. Methods: During the 2024 Iron Swords War, 200 pregnant women beyond 32 weeks’ gestation were recruited at a tertiary hospital near Israel’s northern border. Using questionnaires we assessed perceived stress, intolerance of uncertainty, and fear of childbirth. Maternal and neonatal outcomes were extracted from medical records. Results: A regression analysis revealed that fear of childbirth was significantly predicted by higher perceived stress (β=0.31, P <0.001), greater intolerance of uncertainty (β=0.23, P =0.002), and nulliparity (β=0.13, P =0.045). Together, these variables accounted for 25% of the variance in fear of childbirth (R²=0.25). In addition, perceived stress and intolerance of uncertainty were each significantly correlated with fear of childbirth in bivariate analyses (r=0.42 and r=0.40, respectively). Logistic regression showed that fear of childbirth predicted emergent cesarean delivery (OR=2.63, 95% CI:1.07–5.04, P =0.033). Conclusions: Exposure to war-related stress and uncertainty was linked to heightened fear of childbirth and may impact maternal outcomes. These results emphasize the importance of identifying and addressing psychological distress early in pregnancy, particularly in settings impacted by armed conflict.