Developmental trajectories and predictive factors of fear of childbirth among women planning vaginal delivery: a latent class growth modeling approach

Fear of childbirth (FOC) is a common perinatal psychological problem that increases the risk of complications and postpartum post-traumatic stress disorder. This study used a longitudinal design and latent class growth modeling (LCGM) to identify FOC trajectories and their determinants among women vaginal delivery. This longitudinal prospective study was conducted in the obstetrics department of tertiary hospitals in Changsha, China. A total of 410 pregnant women were recruited during the baseline period from May 2025, with 350 ultimately completing the follow-up. Assessments of FOC, self-efficacy, coping styles, pain catastrophizing, and intolerance of uncertainty were performed at 32–34 weeks (T1), 36–38 weeks (T2), and 1 week postpartum (T3), using the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), General Self-Efficacy Scale (GSES), Trait Coping Style Questionnaire (TCSQ), Pain Catastrophizing Scale (PCS), and Intolerance of Uncertainty Scale (IUS-9), respectively. Repeated-measures ANOVA examined temporal changes in FOC, latent class growth modeling (LCGM) identified trajectories, and multinomial logistic regression determined predictors. FOC peaked at 36–38 weeks of gestation and declined slightly postpartum, although levels remained elevated compared to baseline. Latent class growth modeling identified three distinct trajectories: low-level stable fluctuation (71.9%), low-level steady increase (22.3%), and medium-to-high rise-decline (5.9%). Multinomial logistic regression revealed that, with the low-level stable fluctuation group as reference, maternal age < 30 years (OR = 0.30, p < 0.001), planned pregnancy (OR = 0.14, p < 0.001), participation in prenatal education (OR = 0.19, p < 0.001), and higher negative coping scores (OR = 0.82, p = 0.002) were associated with a lower probability of belonging to the low-level steady increase trajectory. For the medium-to-high rise-decline trajectory, higher positive coping scores (OR = 0.71, p = 0.036) and a monthly household income of 3000–5000 RMB (OR = 0.14, p = 0.049) were associated with a lower probability of membership. The study identified that fear of childbirth (FOC) among women planning vaginal delivery follows heterogeneous developmental trajectories. Recognizing these distinct patterns is crucial for early screening and the development of tailored interventions to support maternal psychological well-being and improve perinatal outcomes.