Menthol Cigarettes and Maternal Health: 2004-2022

Background: The United States is proposing to ban menthol cigarettes. Our objective is to examine the extent of menthol smoking among pregnant women and its association with their health. Methods: Nationally representative study of 14,226 pregnant women aged 18-44 years using the 2004-2022 National Survey on Drug Use and Health. Multivariate regressions estimate the association between menthol smoking and emergency department (ED) and office visits, poor health, mental health, and smoking cessation. Results: In total, 7.0% of pregnant women smoked menthol cigarettes, 7.3% smoked nonmenthol, 11.0% recently quit, and 74.7% were nonsmoking. Lesbian/gay/bisexual women had the highest rates: 18.6% menthol and 11.0% nonmenthol. In the third trimester, 10.4% of Black women smoked menthol and 0.6% smoked nonmenthol (p < 0.01), whereas 5.4% of White women smoked menthol and 8.6% smoked nonmenthol (p < 0.01). From 2004 to 2022, maternal smoking decreased from 16.3% to 5.1%. However, the percentage of pregnant smoking women using menthol increased from 47.0% to 60.1%, with the largest increase among Hispanic women from 43.4% to 78.8% (p < 0.05), compared with a rate of 96.1% among Black women and 49.0% for White women. Pregnant women smoking menthol had 1.6 ED annual visits compared with 1.2 ED visits (p < 0.05) for nonmenthol and 0.6 ED visits (p < 0.05) among the nonsmoking. Among those smoking menthol, 73.7% reported mental health issues compared with 64.4% for nonmenthol. Conclusions: Women who smoke menthols report worse health compared with those smoking nonmenthol. Policies designed to reduce menthol smoking would improve maternal health, especially for minoritized women and those at higher risk for poor birthing outcomes.