OBJECTIVE : Few studies have focused on the fear of childbirth (FOC) in China. This study aimed to explore the status of FOC and its associated factors among nulliparous women in China. METHODS : Using a cross-sectional study design, 1039 nulliparous women with singleton pregnancies were recruited from four public hospitals in four cities of China. FOC was evaluated using the Chinese version of the Childbirth Attitude Questionnaire scale. Associations of demographic, obstetric and social-psychological factors with the levels of FOC among nulliparous women were investigated. RESULTS : The average score on the Childbirth Attitude Questionnaire scale was 31.30 (standard deviation = 8.43). Generalized linear regression analysis revealed that low self-rated health status (β = 2.26, P = 0.003), higher educational levels (β = 2.06, P = 0.010), lower levels of self-efficacy (β = -0.79, P < 0.001), and use of pregnancy-related smartphone applications (β = 2.42, P < 0.001) were associated with higher levels of FOC. CONCLUSIONS : The Childbirth Attitude Questionnaire scale is an appropriate tool to measure FOC. Education levels, self-rated health status, self-efficacy levels, and use of pregnancy-related smartphone applications were predictors of FOC among pregnant women in China. Healthcare professionals should identify the Chinese pregnant women with FOC and implement targeted interventions focused on the above factors.