Parental stress and parent–child dyadic outcomes in preterm populations: a systematic review and meta-analysis

OBJECTIVE: Despite established theoretical links between parental stress and parent-child dyadic functioning, no systematic review has examined these associations in preterm samples. We conducted a systematic review and meta-analysis on associations between parental stress and dyadic outcomes across the first year of life with preterm parent-child dyads. METHODS: Four databases were searched through May 2026 (INPLASY #2025110019). Eligible studies assessed parental stress and parent-child dyadic outcomes in preterm samples within the first year of life. Effects were synthesized based on the timing of stress and dyadic outcome measurement. Parental stress was categorized into four types [parenting, neonatal intensive care unit (NICU)-specific, general, and perceived social support] and dyadic outcomes were categorized into three types (caregiving quality, dyadic coordination, and attachment). Risk of bias/certainty of evidence was assessed. RESULTS: Thirty-four studies were included (N = 3,079 dyads). A significant small association between parental stress and dyadic outcomes was found during NICU hospitalization (r = -.20; low heterogeneity) and at 0-6 months corrected age (r = -.11) postdischarge. No reliable association was found at 7-12 months corrected age. CONCLUSIONS: Parental stress is most reliably linked to dyadic functioning when measured concurrently during NICU hospitalization and did not reliably predict postdischarge dyadic outcomes. Parenting stress and caregiving quality showed the most consistent associations descriptively, though differences across stress types were not statistically supported. Findings suggest that the NICU stay may be an important period for supporting dyadic functioning, with attention to parenting stress and moment-to-moment caregiver responsiveness.