Screening Performance of Hindi Versions of SAAS, WDEQ-10, and STAI-6 for Fear of Childbirth at Term Pregnancy: A Pilot Study

Background: Antenatal anxiety and fear of childbirth (FOC) are common yet under-recognized, especially in the developing world, despite knowing that it affects delivery outcomes as well as birth experience. A study was done to assess the screening performance of Hindi versions of validated anxiety questionnaires in term pregnancy against the Fear-of-Birth Scale. The reliability of Hindi versions of the Stirling Antenatal Anxiety Scale (SAAS), State Trait Anxiety Inventory (STAI-6), and Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ10), along with major determinants of antenatal anxiety. Methods: Cross-sectional observational study of the screening performance of three fear-of-birth scores (SAAS, STAI-6, W-DEQ10) in Hindi, conducted on term pregnant women. The Hindi adaptation was evaluated by experts, pilot-tested, and applied to enrolled pregnancy cases from the antenatal Out-patient department (OPD). Content validity, reliability, correlation, and regression were analyzed. Results: The Hindi versions showed a Content Validity Index of 0.93 (SAAS), 0.88 (W-DEQ-10), and 0.86 (STAI-6); Cronbach’s α values were 0.891 and 0.816, and Kaiser–Meyer–Olkin values were 0.87 (SAAS) and 0.774 (W-DEQ-10). SAAS was found to be the most reliable, with Cohen’s kappa of 0.48, a correlation coefficient ( r ) of 0.563, an area under the curve of 0.77, and a sensitivity of 79%, whereas STAI was the least reliable. Overall antenatal anxiety was noted in 53% of enrolled cases and was significantly higher in at-risk pregnancies ( p = .023). Conclusions: The Hindi SAAS version was found to be the most reliable and feasible tool for antenatal anxiety screening, in agreement with the Fear of Birth Visual Analog Scale. High-risk pregnancy was an independent predictor of anxiety and a high burden (53%) of unrecognized anxiety, supporting the strong need for screening tools in routine maternity settings.