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Recent study examined the heterogeneous progression, interrelationships, and predictive factors of perinatal insomnia and depression across the perinatal period. The researchers used group-based trajectory modeling to identify distinct trajectories of insomnia and depressive symptoms from early pregnancy to 6 months postpartum.

Distinct Trajectories of Insomnia and Depression

The results showed three distinct insomnia trajectories: a “no insomnia” group (27.7%), a “subclinical insomnia” group (54.5%), and a “clinical insomnia” group (17.8%). For depressive symptoms, three trajectories were also identified: a “low-stable” group (38.7%), a “moderate-stable” group (43.9%), and a “high-improving” group.

Interrelationships Between Insomnia and Depression

The dual trajectory analysis revealed significant interrelationships between insomnia and depression, with the severity of symptoms co-occurring. Women in the low-stable depression group predominantly had no insomnia, while those in the moderate-stable depression group mostly had subclinical insomnia, and the high-improving depression group had the highest rates of clinical insomnia.

Predictive Factors for Insomnia and Depression Trajectories

Baseline factors including anxiety scores ≥24, insomnia scores ≥8, and depression scores ≥10 were common predictors of both adverse insomnia and depression trajectories. However, social capital was not a significant predictor.

Implications and Recommendations for Integrated Interventions

These findings highlight the importance of integrated screening and treatment approaches that simultaneously address comorbid insomnia and depression during the perinatal period. Tailored interventions based on symptom trajectory profiles could help improve maternal mental health outcomes. Future research should further explore the temporal dynamics and underlying mechanisms linking these conditions.

Key Points

1. The study examined the heterogeneous progression, interrelationships, and predictive factors of perinatal insomnia and depression across the perinatal period using group-based trajectory modeling.

2. The results showed three distinct trajectories for both insomnia and depressive symptoms – a “no insomnia”/”low-stable” group, a “subclinical insomnia”/”moderate-stable” group, and a “clinical insomnia”/”high-improving” group.

3. The dual trajectory analysis revealed significant interrelationships between insomnia and depression, with the severity of symptoms co-occurring across the three trajectory groups.

4. Baseline factors including anxiety scores ≥24, insomnia scores ≥8, and depression scores ≥10 were common predictors of both adverse insomnia and depression trajectories, but social capital was not a significant predictor.

5. The findings highlight the importance of integrated screening and treatment approaches that simultaneously address comorbid insomnia and depression during the perinatal period.

6. Tailored interventions based on symptom trajectory profiles could help improve maternal mental health outcomes, and future research should further explore the temporal dynamics and underlying mechanisms linking these conditions.

Reference –

Xinlong Pan et al. (2025). Dual Trajectory Of Insomnia And Depressive Symptoms In Women From Early Pregnancy To 6 Months Postpartum: A Prospective Cohort Study. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07649-2.

 Experts representing multiple societies and institutions across 14 countries have published guidance for computed tomography (CT) imaging in patients with residual lung abnormalities after COVID-19 illness. The consensus statement appears today in Radiology, a journal of the Radiological Society of North America (RSNA).

The statement’s authors seek to standardize the indications for when chest CT is appropriate for patients with post–COVID-19 condition, the methods for acquiring images and the terminology used for reporting residual lung abnormalities. The final consensus was reviewed by four expert pulmonologists to ensure alignment with clinical perspectives.

Using standardized and specific terminology when reporting these abnormalities helps to avoid confusion with interstitial lung diseases (ILDs), explained statement coauthor Anna Rita Larici, M.D., an associate professor of radiology at Catholic University of the Sacred Heart of Rome and chief of the Chest Imaging Unit at Advanced Radiology Center of Agostino Gemelli University Polyclinic Foundation in Rome, Italy. It also helps physicians make more informed decisions about patient management, and it captures more precise data for future research.

“These statements recommend employing terms from the Fleischner Society Glossary to describe CT findings consistently and precisely, avoiding the use of ‘interstitial lung abnormality (ILA),’ which refers to a different clinical context,” Dr. Larici said. “In addition, we have coined and recommended the term ‘post–COVID-19 residual lung abnormality’ to prevent any misleading term when describing CT lung abnormalities following COVID-19 pneumonia.”

The authors also outlined the conditions under which chest CT imaging is appropriate for this patient group. They recommend chest CT for patients whose respiratory symptoms continue or worsen three months after infection, with these symptoms lasting for at least two months and with no other explanation. A chest CT scan three to six months after discharge may also be considered for all patients hospitalized with moderate to severe COVID-19 due to the high rate of residual CT lung abnormalities observed in these patients.

The group suggests that follow-up be guided by radiological expertise in conjunction with clinical judgment, considering its frequency based on the extent of initial lung abnormalities, temporal changes and/or pulmonary physiology.

Radiologists should adhere to the “as low as reasonably achievable” (ALARA) principle for serial CT follow-up, using a low-dose protocol within a range of 1 to 3 millisieverts, the authors advised.

“Radiologists play a crucial role in adhering to ALARA principles by optimizing CT protocols—using appropriate low-dose techniques during follow-ups—while maintaining the image quality necessary for accurate assessment,” Dr. Larici said. “This is especially important when serial imaging of these patients is needed, so that we minimize radiation exposure without compromising diagnostic accuracy.”

COVID-19 can cause continuing or worsening symptoms after infection—described as post–COVID-19 condition or “long COVID”—and approximately 6% of individuals who have had COVID-19 are estimated to experience post–COVID-19 condition. Among patients hospitalized for acute COVID-19, on average, 50% show chest CT abnormalities, and 25% have restrictive pulmonary functional abnormalities at four months after infection. Radiologists face several unique challenges when caring for this patient population.

“These include differentiating between persistent residual COVID-19 lung abnormalities and evolving fibrotic changes, interpreting overlapping features such as ground-glass opacities versus fibrosis, and assessing the temporal evolution of these findings,” Dr. Larici explained. “Distinguishing post–COVID-19 residual lung abnormalities from ILA and ILDs is crucial, because they have very different clinical implications: post–COVID-19 changes typically stabilize over time, whereas ILA and ILDs can progress.”

It’s important to understand that post–COVID-19 lung abnormalities can persist for months and potentially impact respiratory health, she said.

“Follow-up imaging plays a key role in assessing these residual changes and guiding clinical care, but it should be performed judiciously. Adherence to established recommendations helps ensure that patients receive follow-up imaging and care only when clinically indicated,” Dr. Larici said.

Dr. Larici noted that being part of a global team of experts working together signifies a collective effort to establish evidence-based, harmonized best practices for caring for patients recovering from post–COVID-19 pneumonia.

“It reflects a commitment to advancing patient care worldwide through shared knowledge, research and consensus,” she said.

Reference:

Soon Ho Yoon, Best Practice: International Multisociety Consensus Statement for Post–COVID-19 Residual Abnormalities on Chest CT Scans, Radiology, https://doi.org/10.1148/radiol.243374