Two research articles in CMAJ examine gaps in how maternal risk is captured and how it varies across populations in Canada. One study shows that extending surveillance beyond delivery reveals a higher burden of severe maternal morbidity, particularly in the postpartum period. A second examines obstetric trauma, identifying differences across racial and immigration groups and pointing to structural and sociocultural factors that shape risk during delivery.

Dr. Giulia Muraca, an obstetrician-gynecologist at McMaster University and principal investigator on the first study, explains that extending surveillance beyond delivery increases estimated rates of severe maternal morbidity from 1.7% to 2.7%, representing nearly 10 000 affected pregnancies annually in Canada. Maya Rajasingham, a perinatal epidemiologist at McMaster and co-author, notes that 29% of these events occur postpartum, with sepsis emerging as a key contributor. Muraca adds that postpartum sepsis rates are substantially higher than previously reported, with most cases occurring in the first week after discharge. She also identifies acute appendicitis as the most frequent severe maternal morbidity in the antepartum period, a finding that remains underexplored in the Canadian literature. The findings suggest current surveillance windows underestimate the true burden of maternal morbidity.

In a second CMAJ study on obstetric trauma, Muraca again serves as principal investigator alongside Irina Oltean, a PhD candidate at McMaster and co-author. The study finds that obstetric trauma affects 5.5% of vaginal births, with substantial variation across racial groups. Oltean reports higher rates among Asian patients and lower rates among Black patients compared with White patients, even after adjusting for clinical factors. Among immigrants, risk declines with increasing time in Canada. The authors suggest this pattern reflects differences in communication, access to care, and familiarity with the health system rather than biological factors.

For clinicians, these studies suggest the need to expand the window of concern beyond delivery and to account for how social and structural factors shape risk across populations.

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New prescriptions for stimulant medications used to treat attention-deficit/hyperactivity disorder (ADHD) doubled during the COVID-19 pandemic compared with the years before it, with the largest increases among adults aged 18 to 34 and among women.

Dr. Tara Gomes, a professor at the University of Toronto and principal investigator of the Ontario Drug Policy Research Network, discusses findings from the CMAJ research article Patterns of prescription stimulant initiation before and during the COVID-19 pandemic. Her team found that the number of Ontarian adults newly starting stimulants rose rapidly after an initial drop early in the pandemic. The interval between a first ADHD-related health care encounter and a stimulant prescription also fell from about seven years before the pandemic to less than one year during it. Gomes suggests the increase likely reflects both improved recognition of ADHD in adults and easier access through virtual care, which may be shortening the pathway from first expression of concern by a patient to prescription.

Dr. Ashley White, a family physician who treats many patients with ADHD and received her own diagnosis in adulthood, reflects on how the condition can go unrecognized in high-performing adults. While she explored her own diagnosis through an online clinic, she emphasizes the importance of careful assessment that accounts for overlapping conditions such as anxiety or trauma, which can benefit from different treatment.

The episode highlights a genuine tension: better recognition of adult ADHD is overdue, but the speed of the shift raises real questions about diagnostic rigour.

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Ontario’s expansion of online gambling and legalization of single-event sports betting were followed by a sharp rise in help-seeking for gambling problems, particularly among young men. A new CMAJ study, Help seeking for gambling problems following expansion of Ontario's online gambling market and legalization of single event sports betting, analyzes calls to Ontario's 24-hour mental health and addiction hotline before and after the 2022 policy changes. The findings suggest that increased accessibility, private-sector expansion, and in-play betting may be amplifying gambling-related harm.

Dr. Daniel Myran, a family physician, research chair in family and community medicine at North York General Hospital, and co-author of the study, reports that hotline contacts among males aged 15 to 24 tripled after the market opened to private operators. By the end of the study period, more than 70% of callers cited online gambling. He describes how legalization of single-event sports betting and in-play betting reduced friction and increased immediacy, features linked to higher addiction risk.

Dr. Daniela Lobo, medical lead of the Problem Gambling and Tech Use Clinic at CAMH and an assistant professor of psychiatry at the University of Toronto, describes seeing younger patients since the introduction of iGaming, including individuals in their late teens and early twenties. She explains how in-play betting mirrors other high-risk formats by offering rapid, repeated opportunities to wager. Gambling disorder shares features with substance use disorders, including tolerance, withdrawal symptoms, concealment, financial strain, and suicidal ideation. She also highlights medication-related risk, noting that dopamine agonists and certain atypical antipsychotics have been linked to new gambling behaviours.

Clinicians should consider gambling when patients present with unexplained financial stress, relationship conflict, mood symptoms, or suicidality, and remain alert to medication-induced behavioural change. Resources like ConnexOntario offer anonymous referral support for patients and providers.

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