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Background: Cannabis is one of the most common non‐prescribed psychoactive substances used in pregnancy. The prevalence of gestational cannabis use is increasing. Aim: The aim was to examine the prevalence of gestational cannabis use and associated pregnancy and neonate outcomes. Materials and Methods: A retrospective observational study involving pregnant women delivering in 2019 was conducted at a tertiary hospital in Perth, Western Australia. Gestational cannabis and other substance use records were based on maternal self‐report. Pregnancy outcomes included neonatal gestational age, birthweight, birth length, head circumference, resuscitation measures, special care nursery admission, 5‐min Apgar score and initial neonatal feeding method. Results: Among 3104 pregnant women (mean age: 31 years), gestational cannabis use was reported by 1.6% (n = 50). Cannabis users were younger, more likely to use other substances and experience mental illness or domestic violence compared with non‐users. Neonates born to cannabis users had a lower mean gestational age, birthweight and birth length compared to those born to non‐cannabis users. Gestational cannabis use (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.6–6.7) and tobacco smoking (OR 2.2, 95% CI 1.5–3.6) were associated with increased odds of a low‐birthweight neonate. Combined cannabis and tobacco use during pregnancy further increased the likelihood of low birthweight (LBW, adjusted OR 3.9, 95% CI 1.6–9.3). Multivariate logistic regression analysis adjusted for maternal sociodemographical characteristics, mental illness, alcohol, tobacco and other substance use demonstrated gestational cannabis use to be independently associated with LBW (OR 2.3, 95% CI 1.1–5.2). Conclusion: Gestational cannabis use was independently associated with low birthweight, synergistically affected by tobacco smoking. [ABSTRACT FROM AUTHOR]

Low‐dose aspirin is commonly used for primary or secondary prophylaxis against cardiovascular disease in older people. However, the potential risk of upper gastrointestinal (UGI) ulceration and bleeding associated with low‐dose aspirin use is often not appreciated by prescribers and older consumers. Among 133 serial patients with UGI bleeding, aspirin‐users aged ≥70 years had a ninefold increased likelihood of overt UGI bleeding compared with non‐users, reducing by 90% in regular proton‐pump inhibitor users (adjusted odds ratio 0.10). We recommend risk‐versus‐benefit discussions when recommending aspirin to older people. [ABSTRACT FROM AUTHOR]

Background: Up to 3% of methotrexate (MTX)‐treated rheumatoid arthritis (RA) patients might develop liver fibrosis or cirrhosis, requiring effective screening algorithms. Aims: To assess the utility of non‐invasive liver fibrosis assessment in RA patients on MTX. Methods: Fifty‐six patients were recruited from rheumatology outpatient clinics in a public tertiary centre from July 2017 to October 2018. Clinical data was collected. Screening for hepatic fibrosis was performed using transient elastography (TE), aminoaspartate transaminase to platelet ratio index (APRI), Hepascore and Fibrosis‐4 index (FIB‐4). Those with suspected significant liver fibrosis based on these screening tests were assessed by a hepatologist. Results: Twenty‐seven patients were suspected to have liver fibrosis on screening, including 10/56 (18%) by TE, 20/56 (36%) by Hepascore, 2/56 by APRI (4%) and 1/56 by FIB‐4 (2%). Of these 27 patients, 11 were reviewed by a hepatologist and one diagnosed with significant liver fibrosis. TE, but not APRI, Hepascore or FIB‐4, was found to have 100% sensitivity and 84% specificity (P = 0.029) for hepatologist‐diagnosed liver fibrosis. Conclusion: Liver fibrosis develops in a minority of MTX‐treated RA patients. The present study suggests that TE is a more sensitive screening test than APRI, FIB‐4 or Hepascore in the identification of people with RA at risk of hepatic fibrosis. [ABSTRACT FROM AUTHOR]