title: Worldwide prevalence of tocophobia in pregnant women: systematic review and meta-analysis.
abstract: BACKGROUND
  Tocophobia is defined as a severe fear of pregnancy and childbirth. There is increasing evidence that tocophobia may have short-term and long-term adverse effects on mother and baby. We performed a systematic review and meta-analysis to determine the global prevalence of tocophobia in pregnancy.
  
  
  METHODS
  Relevant articles were identified through searching six relevant databases: MEDLINE, CINAHL, Pubmed, PsycINFO, Maternity & Infant Care and Scopus between 1946 and April 2016. We used search terms for tocophobia prevalence in pregnant women that we agreed on with a medical librarian. There were no language restrictions. Two review authors independently assessed data for inclusion, extracted data and assessed quality using a standardized appraisal tool. Meta-analysis was performed to determine the overall pooled-prevalence of tocophobia. Several subgroup and sensitivity analyses were conducted.
  
  
  RESULTS
  Thirty-three studies were included in the systematic review from 18 countries of which data from 29 studies were used in the meta-analysis of 853 988 pregnant women. Definition of tocophobia varied, whereas prevalence rates ranged between 3.7 and 43%. The overall pooled prevalence of tocophobia, using a random-effects model, was 14% (95% CI 0.12-0.16). Significant heterogeneity was observed (I2= 99.25%, p = 0.00), which was not explained in subgroup analyses including tocophobia definition used, screening trimester and parity.
  
  
  CONCLUSIONS
  The prevalence of tocophobia is estimated at 14% and appears to have increased in recent years (2000 onwards). Considerable heterogeneity (99.25%) was noted that may be attributed to lack of consensus on the definition of tocophobia, so our results should be interpreted with caution.
authors.affiliation: Irish Centre for Fetal and Neonatal Translational Research (INFANT Center), Department of Obstetrics & Gynecology, Cork University Maternity Hospital, Wilton, Cork, Ireland.
authors.forename: Maeve A
authors.identifier: http://orcid.org/0000-0003-1927-2711
authors.initials: MA
authors.lastname: O'Connell
authors.affiliation: School of Nursing & Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Leahy-Warren
authors.affiliation: Irish Centre for Fetal and Neonatal Translational Research (INFANT Center), Department of Obstetrics & Gynecology, Cork University Maternity Hospital, Wilton, Cork, Ireland.|Department of Epidemiology & Public Health, Western Gateway Building, University College Cork, Cork, Ireland.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Khashan
authors.affiliation: Irish Centre for Fetal and Neonatal Translational Research (INFANT Center), Department of Obstetrics & Gynecology, Cork University Maternity Hospital, Wilton, Cork, Ireland.
authors.forename: Louise C
authors.initials: LC
authors.lastname: Kenny
authors.affiliation: Irish Centre for Fetal and Neonatal Translational Research (INFANT Center), Department of Obstetrics & Gynecology, Cork University Maternity Hospital, Wilton, Cork, Ireland.
authors.forename: Sinéad M
authors.initials: SM
authors.lastname: O'Neill
mesh_terms: D005239:Fear; D005260:Female; D014943:Global Health; D006801:Humans; D000068097:Maternal Health; D036801:Parturition / Q000523:psychology*; D010698:Phobic Disorders / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence
keywords: Epidemiology; W-DEQ A; fear of childbirth; pregnancy; systematic review; tocophobia