{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:18:01Z","timestamp":1787761081211,"version":"build-2784847793"},"reference-count":28,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Procedure<\/jats:title>\n                    <jats:p>A retrospective cohort study was carried out of a health\u2010information database. Eligible subjects included non\u2010pregnant females 12\u201319\u00a0years of age residing in the United States who had at least one ambulatory visit in 2018\u20132023. Prescription data, diagnostic, and procedural codes were used to determine exposure to contraceptives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The final analytical sample included 789,453 subjects. The overall 1\u2010year 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\u20132.37) and COC use versus none had a 65% increased risk of PE (RR = 1.65; 95% CI = 1.14\u20132.40). Among overweight patients, COC use was marginally related to risk of PE (RR = 2.13; 95% CI = 1.00\u20134.56), and among obese patients, there was a two\u2010fold increased risk of PE for COC use versus none (RR = 2.33; 95% CI = 1.18\u20134.60).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Both obesity and COC use increase the relative risk of PE in adolescent females. Their combined effect increases the relative risk two\u2010fold. 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\u2010making when discussing contraceptive use in overweight or obese adolescent females.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70439","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T03:03:46Z","timestamp":1785380626000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Combined Effect of Obesity and Contraceptive Use on Pulmonary Embolism in Adolescent\u00a0Females\u00a0Residing in the United States"],"prefix":"10.1002","volume":"73","author":[{"given":"John","family":"Puetz","sequence":"first","affiliation":[{"name":"Division of Pediatric Hematology\/Oncology, Department of Pediatrics, Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Salas","sequence":"additional","affiliation":[{"name":"AHEAD Institute Saint Louis University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2005.03.012"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.15386\/mpr-1372"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2007.06780.x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.14104"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2011.10.019"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.5482\/HAMO-13-05-0028"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2015-0039"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.3109\/08880018.2014.886315"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019000071"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.25527"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2015.12.005"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-0126"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtha.2024.01.005"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(24)00412-0"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d6423"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h2135"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2010.01.045"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwaa244"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6607"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh090"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2017013292"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.20579"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2018-05-849737"},{"key":"e_1_2_9_25_1","volume-title":"Thrombosis and Emboli","author":"Virchow R.","year":"1998"},{"issue":"5","key":"e_1_2_9_26_1","first-page":"1270","article-title":"Pulmonary Embolism Without Deep Venous Thrombosis: De Novo or Missed Deep Venous Thrombosis?","volume":"76","author":"Van Gent J. 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