Center for Health Innovations in Reproductive and Perinatal Population Research (CHIRP)

This grant aims to utilize data from the National Health and Nutrition Survey (NHANES) linked Medicaid data to create a novel preconception cohort and study the role of preconception lifestyle factors on pregnancy outcomes. The proposed study will evaluate the role of preconception dietary factors, sleep and physical activity, and weight loss attempts and strategies on adverse pregnancy outcomes. The data obtained from this study will provide valuable insights into the role of preconception health factors improving pregnancy outcomes and can inform the development of evidence-based preconception care guidelines.  

Grant Number: R01HD114736

Principal Investigators:

Stefanie N. Hinkle, PhD

Assistant Professor of Epidemiology

Emerging ExposuresEtiology of Population HealthLife Course Epi

Ellen Caniglia, ScD

Assistant Professor of Epidemiology

Causal InferenceHealth EquityLife Course Epi

Almost half of the women of reproductive age in the U.S. are deficient in iodine. We will apply advanced novel methods to measure urinary iodine in women during preconception and throughout pregnancy and in the placenta to estimate the effects of iodine deficiency before and during pregnancy on critical reproductive and perinatal health outcomes including infertility, pregnancy loss, preterm delivery, and birth size. Iodine is a low-cost intervention, that could be used to target women at risk for adverse outcomes.

Grant Number: R01HD111643

Principal Investigator:

Stefanie N. Hinkle, PhD

Assistant Professor of Epidemiology

Emerging ExposuresEtiology of Population HealthLife Course Epi

Current U.S. guidelines recommend a daily “baby” aspirin, begun after the first trimester, to prevent preeclampsia. However, data suggest that a higher dosage of aspirin and initiating treatment immediately upon pregnancy recognition, instead of waiting until 12 weeks’ of pregnancy, may have a greater beneficial effect, while additionally protecting against pregnancy loss. We propose a randomized trial of 162 mg aspirin (equivalent to two “baby” aspirin) begun by 6 weeks’ gestation in a diverse population to evaluate its effect on preventing pregnancy loss and preeclampsia.

Grant Number: R01HD112308

Principal Investigators:

Enrique Schisterman, PhD

Chair, DBEI
Perelman Professor in Biostatistics, Epidemiology and Informatics

Causal InferenceEtiology of Population HealthNovel Methods

Kurt T. Barnhart, MD, MSCE

William Shippen, Jr. Professor of Obstetrics and Gynecology;
Professor of Epidemiology

Life Course Epi

This study will recruit at least 2,500 pregnant people, their partners, and offspring from the University of Pennsylvania and Children’s Hospital of Philadelphia as part of the nationwide ECHO Cohort to understand the role of early exposures on child health outcomes and identify ways to reduce disparities. The health system at Penn and CHOP serves a diverse population underrepresented in other pregnancy and pediatric cohorts in the US (largely Medicaid-insured and plurality Black).

Grant Number: UG3OD035537

Principal Investigators:

Sunni Mumford, PhD

Deputy Director, Epidemiology
Professor of Epidemiology

Causal InferenceClinical TrialsEmerging ExposuresHealth EquityLife Course EpiWearable Devices

Heather H. Burris, MD, MPH

Associate Professor of Pediatrics (Neonatology & Newborn Services) at the Children’s Hospital of Philadelphia

Sara B. Demauro, MD, MSCE

Associate Professor of Pediatrics (Neonatology & Newborn Services) at the Children’s Hospital of Philadelphia

Rates of severe maternal morbidity are rising in the U.S. and disparities in these outcomes are worsening. Telehealth utilization increased dramatically in response to the COVID-19 pandemic and has great potential to reduce severe maternal morbidity and disparities in severe maternal morbidity through increasing prenatal and postpartum care access and utilization. This community engaged mixed methods project will determine the impact of telehealth on severe maternal morbidity and disparities in severe maternal morbidity, and identify best practices for implementation of telehealth to reduce these outcomes.

Grant Number: R01HD113685

Principal Investigators:

Ellen Caniglia, ScD

Assistant Professor of Epidemiology

Causal InferenceHealth EquityLife Course Epi

Meredith Matone, DrPH, MHS

Associate Professor of Pediatrics (General Pediatrics)

Polycystic ovary syndrome is the most common endocrine disorder affecting 10% of reproductive age women and has been associated with an increased risk of heart disease. Hormonal contraceptives and metformin are first line medications, commonly prescribed from an early age and for long durations, even though how they might impact heart disease risk in women with PCOS is unknown. The goal of this project is to understand how these medications impact heart disease, and risk factors for heart disease like diabetes and high cholesterol among two large real-world cohorts of women with PCOS.

Grant Number: PCORI BPS-2022C3-30268

Principal Investigators:

Sunni Mumford, PhD

Deputy Director, Epidemiology
Professor of Epidemiology

Causal InferenceClinical TrialsEmerging ExposuresHealth EquityLife Course EpiWearable Devices

Anuja Dokras, MD, MHCI, PhD

Founder’s Professor in Women’s Health
Department of Obstetrics and Gynecology, Perelman School of Medicine

It can be challenging for decision makers and clinical providers when the results of randomized controlled trials conflict with each other. Currently, there are no standard methods and guidelines that can be used by decision makers in this situation, even though they are often tasked with deciding whether the treatment of interest should be available, for whom the treatment may work and whether another trial is needed. In this study, researchers will reanalyze data from two large trials of preterm birth and 17-alpha-hydroxyprogesterone caproate (17P), a weekly injection that may prevent preterm birth in individuals with a previous preterm birth. The first trial found 17P substantially reduced the risk of preterm birth, but the second confirmatory trial found there was no effect. The methods and solutions the study team develops can be applied to any pair of conflicting randomized trials. 

Grant Number: PCORI ME-2023C2-33341

Principal Investigators:

Ellen Caniglia, ScD

Assistant Professor of Epidemiology

Causal InferenceHealth EquityLife Course Epi

Enrique Schisterman, PhD

Chair, DBEI
Perelman Professor in Biostatistics, Epidemiology and Informatics

Causal InferenceEtiology of Population HealthNovel Methods

Eric Tchetgen Tchetgen, PhD

University Professor; Professor of Biostatistics; Professor of Statistics and Data Science

Causal Inference

DiTosto, J. D., Caniglia, E. C., Hinkle, S. N., Sealy, N., Schisterman, E. F., Johnstone, E., Mendola, P., Mills, J., Hotaling, J., Ryan, G., & Mumford, S. L. (2025). Target trial emulation of preconception serum vitamin D status on fertility outcomes: a couples-based approach. Fertility and Sterility, 123(2), 300-312. https://doi.org/https://doi.org/10.1016/j.fertnstert.2024.08.332

Elser, H., Mumford, S. L., Grantz, K. L., Pollack, A. Z., Mendola, P., Mills, J. L., Yeung, E., Zhang, C., Schisterman, E. F., & Hinkle, S. N. (2025). Postpartum Haemorrhage and Long‐Term Mortality. Paediatric and perinatal epidemiology., 39(3), 244-253. https://doi.org/10.1111/ppe.13166

Lee, I. T., Rees, J., King, S., Kim, A., Cherlin, T., Hinkle, S., Mumford, S. L., & Dokras, A. (2025). Depression, Anxiety, and Risk of Metabolic Syndrome in Women With Polycystic Ovary Syndrome: A Longitudinal Study. The Journal of Clinical Endocrinology & Metabolism, 110(3), e750-e756. https://doi.org/10.1210/clinem/dgae256

Matsumoto, M. M., Schisterman, E. F., Soulen, M. C., Reddy, S., Sheng, M., Khaddash, T., Damjanov, N., Furth, E. E., Hunt, S. J., Nadolski, G. J., Kaplan, D. E., & Gade, T. P. F. (2025). Targeting Ischemia-Induced Autophagy Dependence in Hepatocellular Carcinoma: The Phase I–II Hydroxychloroquine-Transarterial Chemoembolization (qTACE) Trial. Journal of Vascular and Interventional Radiology, 36(1), 175-178. https://doi.org/10.1016/j.jvir.2024.08.012

Pineles, B. L., Bonafide, C. P., & Ashcraft, L. E. (2025). Deimplementation of ineffective and harmful medical practices: a data-driven commentary. Am J Epidemiol, 194(4), 889-897. https://doi.org/10.1093/aje/kwae285

Smith, A. J., Pancoe, S., Lynch, M. P., Wachlin, M., Powell, K., Hinkle, S. N., Koelper, N. C., Doherty, M., Bekelman, J. E., Simpkins, F., & Ko, E. M. (2025). Rideshare services for transportation assistance in gynecologic oncology: a quality improvement study. BMC Health Services Research, 25(1), 251. https://doi.org/10.1186/s12913-025-12296-6

Wagner, K. A., Chen, Z., Hinkle, S. N., Gleason, J. L., Lee, W., Grobman, W. A., Owen, J., Newman, R. B., Skupski, D. W., He, D., Sherman, S., Gore-Langton, R. E., Zhang, C., Grewal, J., & Grantz, K. L. (2025). Relationship between Gestational Weight Gain with Fetal Body Composition and Organ Volumes in the NICHD Fetal 3D Study: A Prospective Pregnancy Cohort. The American Journal of Clinical Nutrition, 121(2), 367-375. https://doi.org/10.1016/j.ajcnut.2024.12.007

Wong, J., & Margolis, D. (2025). 29: Association of Food Allergy Status with Control and Long-Term Persistence of Atopic Dermatitis: A Longitudinal Analysis of the Pediatric Eczema Elective Registry. Journal of Investigative Dermatology, 145(3), e8. https://doi.org/10.1016/j.jid.2025.02.040

Albanowski, K., Brent, C., Landrigan, C. P., Benjamin Wolk, C., Schondelmeyer, A. C., Brady, P. W., Beidas, R. S., Schisterman, E. F., Bonafide, C. P., & Network, P. R. i. I. S. (2024). Getting Started With Multi-site Research: Lessons From the Eliminating Monitor Overuse (EMO) Study. Hospital Pediatrics, 14(3), e181-e188. https://doi.org/10.1542/hpeds.2023-007550

Azria, E., Haaser, T., Schmitz, T., Froeliger, A., Bouchghoul, H., Madar, H., Pineles, B. L., & Sentilhes, L. (2024). The ethics of induction of labor at 39 weeks in low-risk nulliparas in research and clinical practice. American Journal of Obstetrics and Gynecology, 230(3, Supplement), S775-S782. https://doi.org/https://doi.org/10.1016/j.ajog.2023.07.037

Bartal, M., Blackwell, S., Zvavanjanja, R., Papanna, R., Sibai, B., Pineles, B., Coselli, J., & Ghorayeb, T. (2024). Leaving the Placenta In Situ in Placenta Accreta Spectrum Disorders: A Single-Center Case Series. American Journal of Perinatology, 41, e420–e429. https://doi.org/10.1055/a-1885-1942

Bouchghoul, H., Madar, H., Resch, B., Pineles, B. L., Mattuizzi, A., Froeliger, A., & Sentilhes, L. (2024). Uterine-sparing surgical procedures to control postpartum hemorrhage. American Journal of Obstetrics & Gynecology, 230(3), S1066-S1075.e1064. https://doi.org/10.1016/j.ajog.2022.06.018

Chakraborti, Y., Hinkle, S. N., Jensen, J. S., Haggerty, C. L., Darville, T., Mumford, S. L., Schisterman, E. F., Silver, R. M., & Taylor, B. D. Preconception Chlamydia trachomatis seropositivity and fecundability, live birth, and adverse pregnancy outcomes. Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2024.12.017

Francis, E. C., Hunt, K. J., Grobman, W. A., Skupski, D. W., Mani, A., & Hinkle, S. N. (2024). Maternal Obesity and Differences in Child Urine Metabolome. Metabolites, 14(11), 574. https://www.mdpi.com/2218-1989/14/11/574

Fuxench, Z. C. C., Mitra, N., Wong, J., Hoffstad, O., Hinkle, S., & Margolis, D. J. (2024). Maternal history of angioma is associated with infantile hemangioma and port-wine stain in children: a population-based, cohort study of mother-child pairs from the United Kingdom. Archives of Dermatological Research, 316(8), 506. https://doi.org/10.1007/s00403-024-03247-y

Joseph, K. S., Lisonkova, S., Boutin, A., Muraca, G. M., Razaz, N., John, S., Sabr, Y., Chan, W.-S., Mehrabadi, A., Brandt, J. S., Schisterman, E. F., & Ananth, C. V. (2024). Maternal mortality in the United States: are the high and rising rates due to changes in obstetrical factors, maternal medical conditions, or maternal mortality surveillance? American Journal of Obstetrics & Gynecology, 230(4), 440.e441-440.e413. https://doi.org/10.1016/j.ajog.2023.12.038

Joseph, K. S., Lisonkova, S., Boutin, A., Muraca, G. M., Razaz, N., John, S., Sabr, Y., Chan, W.-S., Mehrabadi, A., Brandt, J. S., Schisterman, E. F., & Ananth, C. V. (2024). Why improved surveillance is critical for reducing maternal deaths in the United States: a response to the American College of Obstetricians and Gynecologists. American Journal of Obstetrics & Gynecology, 231(2), e87-e92. https://doi.org/10.1016/j.ajog.2024.05.003

Joseph, K. S., Lisonkova, S., Boutin, A., Muraca, G. M., Razaz, N., John, S., Sabr, Y., Simon, S., Kögl, J., Suarez, E. A., Chan, W.-S., Mehrabadi, A., Brandt, J. S., Schisterman, E. F., & Ananth, C. V. (2024). Spatiotemporal patterns and surveillance artifacts in maternal mortality in the United States: a population-based study. The Lancet Regional Health – Americas, 39, 100902. https://doi.org/https://doi.org/10.1016/j.lana.2024.100902

Joseph, K. S., Lisonkova, S., John, S., Sabr, Y., Boutin, A., Muraca, G. M., Razaz, N., Chan, W.-S., Mehrabadi, A., Brandt, J. S., Schisterman, E. F., & Ananth, C. V. (2024). Temporal changes in maternal mortality in the United States. American Journal of Obstetrics & Gynecology, 231(2), e96-e98. https://doi.org/10.1016/j.ajog.2024.04.056

McCaffrey, D. F., Griffin, B. A., Robbins, M., Chakraborti, Y., Coffman, D. L., & Vegetabile, B. (2024). Estimating generalized propensity scores with survey and attrition weighted data. Statistics in Medicine, 43(11), 2183-2202. https://doi.org/https://doi.org/10.1002/sim.10039

Mitro, S. D., Sundaram, R., Grandi, S. M., Hinkle, S. N., Mills, J. L., Mendola, P., Mumford, S. L., Qiao, Y., Cifuentes, A., Zhang, C., Schisterman, E. F., & Grantz, K. L. (2024). Cesarean delivery, labor duration, and mothers’ mortality risk over 50 years of follow-up. American Journal of Obstetrics & Gynecology MFM, 6(11), 101498. https://doi.org/https://doi.org/10.1016/j.ajogmf.2024.101498

Mitro, S. D., Sundaram, R., Qiao, Y., Gleason, J. L., Yeung, E., Hinkle, S. N., Mendola, P., Mills, J. L., Grandi, S. M., Mumford, S. L., Schisterman, E. F., Zhang, C., & Grantz, K. L. (2024). History of multifetal gestation and long-term maternal mortality. Paediatric and Perinatal Epidemiology, 38(3), 219-226. https://doi.org/https://doi.org/10.1111/ppe.13020

Na, M., Shetty, S. S., Niu, X., Hinkle, S. N., Zhang, C., & Gao, X. (2024). Sleep duration, napping behaviors and restless legs syndrome during pregnancy and the trajectories of ultrasonographic measures of fetal growth: Findings from the NICHD Fetal Growth Studies–Singletons. Sleep Health, 10(4), 462-469. https://doi.org/https://doi.org/10.1016/j.sleh.2024.04.004

Pineles, B. L., Vial, M., Castro, T., Ghorayeb, T., Ajishegiri, O., Sadek, S., Pedroza, C., Blackwell, S. C., Chauhan, S. P., & Sibai, B. M. (2024). Ambulation for latency during expectant management of preterm prelabor rupture of membranes: a randomized controlled trial (AMBLE). American Journal of Obstetrics & Gynecology MFM, 6(1), 101218. https://doi.org/https://doi.org/10.1016/j.ajogmf.2023.101218

Shaaban, M., Shepelak, Z. D., Stanford, J. B., Silver, R. M., Mumford, S. L., Schisterman, E. F., Hinkle, S. N., Nkoy, F. L., Theilen, L., Page, J., Woo, J. G., Brown, B. H., Varner, M. W., & Schliep, K. C. (2024). Low-dose aspirin, maternal cardiometabolic health, and offspring respiratory health 9 to 14 years after delivery: Findings from the EAGeR Follow-up Study. Paediatric and Perinatal Epidemiology, 38(7), 570-580. https://doi.org/https://doi.org/10.1111/ppe.13097

Wagner, K. A., Gleason, J. L., Chen, Z., Zhang, C., Hinkle, S. N., He, D., Lee, W., Newman, R. B., Owen, J., Skupski, D. W., Grobman, W. A., Sherman, S., Tekola-Ayele, F., Grewal, J., & Grantz, K. L. (2024). Maternal Glycemic Status and Longitudinal Fetal Body Composition and Organ Volumes Based on Three-Dimensional Ultrasonography. Diabetes Care, 47(12), 2180-2188. https://doi.org/10.2337/dc24-1068

Yisahak, S. F., Hinkle, S. N., Mumford, S. L., Grantz, K. L., Zhang, C., Newman, R. B., Grobman, W. A., Albert, P. S., Sciscione, A., Wing, D. A., Owen, J., Chien, E. K., Buck Louis, G. M., & Grewal, J. (2024). Nutritional Intake in Dichorionic Twin Pregnancies: A Descriptive Analysis of a Multisite United States Cohort. Maternal and Child Health Journal, 28(2), 206-213. https://doi.org/10.1007/s10995-023-03802-5