The Combined Effect of Obesity and Contraceptive Use on Pulmonary Embolism in Adolescent Females Residing in the United States

Background Combined oral contraceptive (COC) use in obese adult women dramatically increases the relative risk of developing a pulmonary embolism (PE). The risk of a PE in obese adolescent females taking contraceptives is currently unknown. The purpose of this investigation was to determine the effect of body mass index (BMI) and contraceptive use on PE in adolescent females. Procedure A retrospective cohort study was carried out of a health‐information database. Eligible subjects included non‐pregnant females 12–19 years of age residing in the United States who had at least one ambulatory visit in 2018–2023. Prescription data, diagnostic, and procedural codes were used to determine exposure to contraceptives. Results The final analytical sample included 789,453 subjects. The overall 1‐year incidence of PE was 16.7 per 100,000 patients. Obese versus normal weight adolescents had a 56% increased risk of PE (relative risk [RR] = 1.56; 95% confidence interval [CI] = 1.03–2.37) and COC use versus none had a 65% increased risk of PE (RR = 1.65; 95% CI = 1.14–2.40). Among overweight patients, COC use was marginally related to risk of PE (RR = 2.13; 95% CI = 1.00–4.56), and among obese patients, there was a two‐fold increased risk of PE for COC use versus none (RR = 2.33; 95% CI = 1.18–4.60). Conclusions Both obesity and COC use increase the relative risk of PE in adolescent females. Their combined effect increases the relative risk two‐fold. Although the relative risk is elevated, the absolute risk remains low. Most obese adolescent females who take COC will not develop a PE. However, these data may be useful for shared decision‐making when discussing contraceptive use in overweight or obese adolescent females.