Mackenzie Tveit

Addressing Intrapartum Marijuana Use in Teton County, Wyoming: A Community-Based Educational Intervention

Mackenzie Tveit Background: Marijuana use in Teton County is 10.1% higher compared to the other counties in Wyoming. Jackson, the county seat and largest town in Teton County, presents a strategic opportunity for much-needed patient education on marijuana use because it is the primary site of obstetric care in Western Wyoming. Therefore, evidence-based education targeting intrapartum marijuana use in Jackson can improve maternal and fetal outcomes in Western Wyoming as a whole. Objective: Development and implementation of a community-based and culturally relevant intervention aimed at increasing awareness of the risks associated with intrapartum marijuana use among obstetric patients in Western Wyoming. Methods: A literature review was conducted to assess the demographic and health disparities in Teton County and to explore the adverse maternal and fetal outcomes linked to intrapartum marijuana use. Four community interviews with healthcare professionals and long-time residents were performed to gain insight into local needs and determine the most effective intervention format. Results: THC, the active ingredient in marijuana, crosses the placenta and can affect fetal development as early as 14 weeks gestation. It alters the placenta via decreased cell viability and proliferation, as well as increased oxidative stress and subsequent apoptosis. As a result of these mechanisms, intrapartum marijuana use is associated with increased risks of adverse outcomes such as small-for-gestational-age infants, decreased head circumference, preterm delivery, NICU admission, and intrauterine fetal demise. Long-term risks for children include memory deficits, attention and achievement challenges, psychosis, substance use disorders and reduced cognitive function. Despite these associations, 34-60% of patients continue marijuana use while pregnant, often as a means of treating nausea and/or anxiety. Research also showed that a fact-based, non-narrative approach is best for reducing rates of marijuana use. Based on these findings and the insight from local interviewees, an educational poster was created to present these risks in accessible yet educational terms. Posters, available in English and Spanish, were placed in exam rooms at the OB-GYN office and public health clinic, which see all of the obstetric patients within and around Jackson. Each poster included a QR code linking to crisis lines, additional data on intrapartum marijuana use, and local resources for support. Conclusion: This intervention provides a culturally relevant and accessible method for educating obstetric patients about the risks of intrapartum marijuana use. Further education could be provided on alternatives to marijuana that will still treat nausea and anxiety while decreasing risk for adverse maternal-fetal outcomes. Future studies could evaluate the impact of these posters on patient awareness and behavior. This could include measuring rates of intrapartum marijuana use before and after exposure to the poster.