The effect of childhood maltreatment on sexual attitudes and fear of childbirth among pregnant women

Objective: To examine the association of childhood maltreatment with sexual attitudes during pregnancy and fear of childbirth among pregnant women. Methods: This cross-sectional study was conducted using an online survey across Türkiye. A total of 313 pregnant women aged ≥18 years and at ≥14 weeks of gestation were included. Data were collected using the Childhood Trauma Questionnaire-33 (CTQ-33), the Attitudes Toward Sexuality During Pregnancy Scale (ASSP), and the Childbirth Fear Scale (CFS). Childhood maltreatment was assessed based on CTQ-33 total scores. Descriptive statistics, group comparisons, and Pearson correlation analyses were performed. Structural equation modelling (SEM) was used to evaluate direct and indirect relationships between childhood maltreatment, sexual attitudes, and fear of childbirth. Results: Childhood maltreatment was positively associated with sexual attitudes during pregnancy (standardized β = 0.25, p < 0.001, 95% CI [0.15, 0.38]). No meaningful direct association was observed between childhood maltreatment and fear of childbirth (β = 0.03, p = 0.648, 95% CI [−0.10, 0.16]). Correlation analyses supported these findings, showing a positive relationship between CTQ-33 and ASSP total scores (r = 0.247, 95% CI [0.14, 0.35]), while the association with CFS total scores was very weak (r = 0.045, 95% CI [−0.06, 0.15]). At the subtype level, small positive correlations were observed between emotional abuse (r = 0.134, 95% CI [0.02, 0.24]) and physical abuse (r = 0.159, 95% CI [0.05, 0.26]) with fear of childbirth. Higher levels of fear of childbirth (indicated by lower CFS scores) were associated with higher maternal education, higher partner education, and lower perceived income levels. The SEM demonstrated acceptable fit (χ2/df = 2.69, RMSEA = 0.074, CFI = 0.901, GFI = 0.992) and explained 6.1% of the variance in sexual attitudes (R2 = 0.061), while explaining very weak variance in fear of childbirth. Conclusions: Childhood maltreatment was associated with sexual attitudes during pregnancy but did not show a clear direct association with fear of childbirth at the total score level. Nevertheless, small subtype-specific associations suggest that different forms of maltreatment may influence fear of childbirth through more complex and indirect pathways. These findings highlight the importance of trauma-informed and context-sensitive antenatal care, particularly in addressing sexual health and psychosocial well-being.