Accumulating evidence suggests that psychological distress during pregnancy is linked to offspring risk for externalizing outcomes (e.g., reactive/aggressive behaviors, hyperactivity, and impulsivity). Effect sizes across studies have varied widely, however, due to differences in study design and methodology, including control for the confounding continuation of distress in the postnatal period. Clarifying these inconsistencies is necessary to guide the precision of prevention efforts and inform public health policies. A meta-analysis was conducted with 55 longitudinal studies to investigate the association between prenatal psychological distress (anxiety, depression, and perceived stress) and offspring externalizing behaviors. Results revealed a significant but small effect (r = .160) of prenatal distress on externalizing behaviors. The magnitude of the prenatal effect size remained largely unchanged after adjusting for postnatal distress (r = .159), implicating a unique effect of psychological distress during the prenatal period in the etiology of externalizing behaviors. Moderation tests showed that prenatal effects did not vary based on type and timing of psychological distress during pregnancy. Greater instability of distress from prenatal to postnatal periods predicted larger effects. Prenatal effects were comparable across most externalizing outcomes, consistent with the common comorbidity of externalizing spectrum disorders, although effects appeared smaller for nonaggressive rule-breaking (vs. aggressive) behaviors. Significant associations persisted across all developmental periods, appearing slightly larger in early childhood. We discuss these results in the context of developmental and psychobiological theories of externalizing behavior, offer preliminary clinical and public health implications, and highlight directions for future research including the need for longitudinal studies with more racially and socioeconomically diverse families. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

中文翻译：

---

产前压力和儿童期和青春期的外化行为：系统评价和荟萃分析。

越来越多的证据表明，怀孕期间的心理困扰与后代外化结果（例如反应性/攻击性行为、多动和冲动）的风险有关。然而，由于研究设计和方法的差异，包括对产后持续的令人困惑的痛苦的控制，各研究的效果大小差异很大。澄清这些不一致之处对于指导预防工作的准确性和为公共卫生政策提供信息是必要的。对 55 项纵向研究进行荟萃分析，以调查产前心理困扰（焦虑、抑郁和感知压力）与后代外化行为之间的关联。结果显示，产前痛苦对外化行为有显着但微小的影响（r = .160）。在调整产后痛苦后，产前效应大小基本保持不变（r = .159），这表明产前期间心理困扰在外化行为的病因学中具有独特的影响。适度测试表明，产前影响并不因怀孕期间心理困扰的类型和时间而异。从产前到产后期间的痛苦的更大的不稳定性预示着更大的影响。大多数外化结果的产前影响是可比的，与外化谱系障碍的常见合并症一致，尽管对于非攻击性违反规则（与攻击性）行为的影响似乎较小。显着的关联在所有发育时期都持续存在，在幼儿期表现得稍大一些。我们在外化行为的发展和心理生物学理论的背景下讨论这些结果，提供初步的临床和公共卫生影响，并强调未来研究的方向，包括对种族和社会经济更加多样化的家庭进行纵向研究的需要。（PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。