Center for Health Innovations in Reproductive and Perinatal Population Research (CHIRP)
CHIRP advances cutting-edge epidemiological research in reproductive and perinatal health, improving population health outcomes for individuals and children.
Our Research
CHIRP investigates critical determinants of reproductive health, exploring how factors such as gynecologic and andrologic health, fertility, pregnancy, fetal development, and early childhood health shape long-term outcomes. By leveraging innovative epidemiologic methodologies, causal inference, and machine learning approaches, CHIRP addresses pressing questions in reproductive and perinatal health. Through this work, CHIRP strives to advance scientific knowledge and inform effective interventions that promote healthier lives.
Funded Research Projects
Explore CHIRP’s funded projects to see how our researchers are advancing understanding of reproductive health—uncovering key factors that influence fertility, pregnancy, maternal health, and early childhood outcomes.
Utilizing the NHANES-Linked Medicaid Data to Understand the Role of Preconception Lifestyle Factors on Pregnancy Outcomes
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
Ellen Caniglia, ScD
Assistant Professor of Epidemiology
Iodine Deficiency: Novel Assessment Methods and Implications for Reproductive Health
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
Early Double Low-Dose Aspirin to Reduce Preeclampsia and Miscarriage: A Global Approach RCT
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
Kurt T. Barnhart, MD, MSCE
William Shippen, Jr. Professor of Obstetrics and Gynecology;
Professor of Epidemiology
Penn-CHOP ECHO
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
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
The Impact Of and Path Forward for Telehealth on Reducing Disparities in Severe Maternal Morbidity: A Community Engaged Mixed-Methods Study
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
Meredith Matone, DrPH, MHS
Associate Professor of Pediatrics (General Pediatrics)
Improving Cardiovascular Health in Polycystic Ovary Syndrome
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
Anuja Dokras, MD, MHCI, PhD
Founder’s Professor in Women’s Health
Department of Obstetrics and Gynecology, Perelman School of Medicine
Methods for Reconciling Conflicting Results from Randomized Trials
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
Enrique Schisterman, PhD
Chair, DBEI
Perelman Professor in Biostatistics, Epidemiology and Informatics
Eric Tchetgen Tchetgen, PhD
University Professor; Professor of Biostatistics; Professor of Statistics and Data Science
Publications
Dive into CHIRP’s latest publications, where cutting-edge research expands our understanding of reproductive, perinatal, and population health—informing policies, shaping practices, and driving meaningful change.
2025
Elser H, Mumford SL, Grantz KL, Pollack AZ, Mendola P, Mills JL, Yeung E, Zhang C, Schisterman EF, Hinkle SN: Postpartum hemorrhage and long-term maternal mortality. Paediatric and Perinatal Epidemiology, in press. Published with commentary.
Matsumoto MM, Schisterman EF, Soulen MC, Reddy S, Sheng M, Khaddash T, Damjanov N, Furth EE, Hunt SJ, Nadolski GJ, Kaplan DE, Gade TPF. Targeting ischemia-induced autophagy dependence in hepatocellular carcinoma: The Phase I-II Hydroxychloroquine-Transarterial Chemoembolization (qTACE) trial. J Vasc Interv Radiol. 2025 Jan;36(1):175-178. doi: 10.1016/j.jvir.2024.08.012. Epub 2024 Aug 23. PMID: 39181530.
Pineles BL, Bonafide CP, Ashcraft LE. Deimplementation of ineffective and harmful medical practices: A data-driven commentary. Am J Epidemiol. 2024 Aug 14:kwae285. doi: 10.1093/aje/kwae285. Epub ahead of print. PMID: 39142696.
Smith AJ, Pancoe S, Lynch MP, Wachlin M, Powell K, Hinkle SN, Koelper NC, Doherty M, Bekelman JE, Simpkins F, Ko EM. Rideshare services for transportation assistance in gynecologic oncology: A quality improvement study. BMC Health Services Research, in press.
Wagner KA, Chen Z, Hinkle SN, Gleason JL, Lee W, Grobman WA, Owen J, Newman RB, Skupski DW, He D, Sherman S, Gore-Langton RE, Zhang C, Grewal J, Grantz KL: Relationship between gestational weight gain with fetal body composition and organ volumes in the NICHD fetal 3D study: A prospective pregnancy cohort. American Journal of Clinical Nutrition, in press with commentary.
2024
Albanowski K, Brent C, Landrigan CP, Benjamin Wolk C, Schondelmeyer AC, Brady PW, Beidas RS, Schisterman EF, Bonafide CP; Pediatric Research in Inpatient Settings (PRIS) Network. Getting started with multi-site research: Lessons from the eliminating monitor overuse (EMO) study. Hosp Pediatr. 2024 Mar 1;14(3):e181-e188. doi: 10.1542/hpeds.2023-007550. PMID: 38410860; PMCID: PMC10896739.
Azria E, Haaser T, Schmitz T, Froeliger A, Bouchghoul H, Madar H, Pineles BL, Sentilhes L. The ethics of induction of labor at 39 weeks in low-risk nulliparas in research and clinical practice. Am J Obstet Gynecol. 2024 Mar;230(3S):S775-S782. doi: 10.1016/j.ajog.2023.07.037. Epub 2023 Aug 24. PMID: 37633577.
Bouchghoul H, Madar H, Resch B, Pineles BL, Mattuizzi A, Froeliger A, Sentilhes L. Uterine-sparing surgical procedures to control postpartum hemorrhage. Am J Obstet Gynecol. 2024 Mar;230(3S):S1066-S1075.e4. doi: 10.1016/j.ajog.2022.06.018. Epub 2023 Aug 23. PMID: 37729440.
Chakraborti Y, Hinkle SN, Jensen JS, Haggerty CL, Darville T, Mumford SL, Schisterman EF, Silver RM, Taylor BD. Preconception Chlamydia trachomatis seropositivity and fecundability, live birth, and adverse pregnancy outcomes. Fertil Steril. 2024 Dec 18:S0015-0282(24)02448-8. doi: 10.1016/j.fertnstert.2024.12.017. Epub ahead of print. PMID: 39701359.
DiTosto JD, Caniglia EC, Hinkle SN, Sealy N, Schisterman EF, Johnstone E, Mendola P, Mills J, Hotaling J, Ryan G, Mumford SL. Target trial emulation of preconception serum vitamin D status on fertility outcomes: A couples-based approach. Fertil Steril. 2025 Feb;123(2):300-312. doi: 10.1016/j.fertnstert.2024.08.332. Epub 2024 Aug 20. PMID: 39173703; PMCID: PMC11788044.
Francis EC, Hunt KJ, Grobman WA, Skupski DW, Mani A, Hinkle SN. Maternal obesity and differences in child urine metabolome. Metabolites. 2024 Oct 25;14(11):574. doi: 10.3390/metabo14110574. PMID: 39590810; PMCID: PMC11596954.
Fuxench ZCC, Mitra N, Wong J, Hoffstad O, Hinkle S, Margolis DJ. 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. Arch Dermatol Res. 2024 Aug 7;316(8):506. doi: 10.1007/s00403-024-03247-y. PMID: 39110228.
Joseph KS, Lisonkova S, Boutin A, Muraca GM, Razaz N, John S, Sabr Y, Chan WS, Mehrabadi A, Brandt JS, Schisterman EF, Ananth CV. 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? Am J Obstet Gynecol. 2024 Apr;230(4):440.e1-440.e13. doi: 10.1016/j.ajog.2023.12.038. Epub 2024 Mar 12. PMID: 38480029.
Joseph KS, Lisonkova S, Boutin A, Muraca GM, Razaz N, John S, Sabr Y, Chan WS, Mehrabadi A, Brandt JS, Schisterman EF, Ananth CV. Why improved surveillance is critical for reducing maternal deaths in the United States: A response to the American College of Obstetricians and Gynecologists. Am J Obstet Gynecol. 2024 Aug;231(2):e87-e92. doi: 10.1016/j.ajog.2024.05.003. Epub 2024 May 9. PMID: 38729595.
Joseph KS, Lisonkova S, John S, Sabr Y, Boutin A, Muraca GM, Razaz N, Chan WS, Mehrabadi A, Brandt JS, Schisterman EF, Ananth CV. Temporal changes in maternal mortality in the United States. Am J Obstet Gynecol. 2024 Aug;231(2):e96-e98. doi: 10.1016/j.ajog.2024.04.056.
Joseph KS, Lisonkova S, Boutin A, Muraca GM, Razaz N, John S, Sabr Y, Simon S, Kögl J, Suarez EA, Chan WS, Mehrabadi A, Brandt JS, Schisterman EF, Ananth CV. Spatiotemporal patterns and surveillance artifacts in maternal mortality in the United States: A population-based study. Lancet Reg Health Am. 2024 Oct 4;39:100902. doi: 10.1016/j.lana.2024.100902. PMID: 39430883; PMCID: PMC11489048.
Lee IT, Rees J, King S, Kim A, Cherlin T, Hinkle S, Mumford SL, Dokras A. Depression, anxiety, and risk of metabolic syndrome in women with polycystic ovary syndrome: A longitudinal study. J Clin Endocrinol Metab. 2024 Apr 13:dgae256. doi: 10.1210/clinem/dgae256. Epub ahead of print. PMID: 38609160.
McCaffrey DF, Griffin BA, Robbins M, Chakraborti Y, Coffman DL, Vegetabile B. Estimating generalized propensity scores with survey and attrition weighted data. Stat Med. 2024 May 20;43(11):2183-2202. doi: 10.1002/sim.10039. Epub 2024 Mar 26. PMID: 38530199; PMCID: PMC11102327.
Mitro SD, Sundaram R, Grandi SM, Hinkle SN, Mills JL, Mendola P, Mumford SL, Qiao Y, Cifuentes A, Zhang C, Schisterman EF, Grantz KL. Cesarean delivery, labor duration, and mothers’ mortality risk over 50 years of follow-up. Am J Obstet Gynecol MFM. 2024 Nov;6(11):101498. doi: 10.1016/j.ajogmf.2024.101498. Epub 2024 Sep 19. PMID: 39305994; PMCID: PMC11563887.
Mitro SD, Sundaram R, Qiao Y, Gleason JL, Yeung E, Hinkle SN, Mendola P, Mills JL, Grandi SM, Mumford SL, Schisterman EF, Zhang C, Grantz KL. History of multifetal gestation and long-term maternal mortality. Paediatr Perinat Epidemiol. 2024 Mar;38(3):219-226. doi: 10.1111/ppe.13020. Epub 2023 Nov 15. PMID: 37969031; PMCID: PMC10978292.
Na M, Shetty SS, Niu X, Hinkle SN, Zhang C, Gao X. 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. 2024 Aug;10(4):462-469. doi: 10.1016/j.sleh.2024.04.004. Epub 2024 Jun 10. PMID: 38862351.
Pineles BL, Coselli J, Ghorayeb T, Fishel Bartal M, Zvavanjanja RC, Blackwell SC, Papanna R, Sibai BM. Leaving the placenta in situ in placenta accreta spectrum disorders: A single-center case series. Am J Perinatol. 2024 May;41(S 01):e420-e429. doi: 10.1055/a-1885-1942. Epub 2022 Jun 25. PMID: 35752168.
Pineles BL, Vial M, Castro T, Ghorayeb T, Ajishegiri O, Sadek S, Pedroza C, Blackwell SC, Chauhan SP, Sibai BM. Ambulation for latency during expectant management of preterm prelabor rupture of membranes: a randomized controlled trial (AMBLE). Am J Obstet Gynecol MFM. 2024 Jan;6(1):101218. doi: 10.1016/j.ajogmf.2023.101218. Epub 2023 Nov 8. PMID: 37944668.
Shaaban M, Shepelak ZD, Stanford JB, Silver RM, Mumford SL, Schisterman EF, Hinkle SN, Nkoy FL, Theilen L, Page J, Woo JG, Brown BH, Varner MW, Schliep KC: Low-dose aspirin, maternal cardiometabolic health, and offspring respiratory health 9 to 14 years after delivery: Findings from the EAGeR Follow-up Study. Paediatr Perinat Epidemiol. 2024 Sep;38(7):570-580. doi: 10.1111/ppe.13097. Epub 2024 Jun 17. PMID: 38886184; PMCID: PMC11427166.
Wagner KA, Gleason JL, Chen Z, Zhang C, Hinkle SN, He D, Lee W, Newman RB, Owen J, Skupski DW, Grobman WA, Sherman S, Tekola-Ayele F, Grewal J, Grantz KL. Maternal glycemic status and longitudinal fetal body composition and organ volumes based on three-dimensional ultrasonography. Diabetes Care. 2024 Dec 1;47(12):2180-2188. doi: 10.2337/dc24-1068. PMID: 39413344; PMCID: PMC11655410.
Wong JJ, Margolis DJ. Association between food allergy status and atopic dermatitis control and persistence: A longitudinal analysis of the pediatric eczema elective registry. Pediatr Dermatol. 2024 Dec 10. doi: 10.1111/pde.15845. Epub ahead of print. PMID: 39659045.
Yisahak SF, Hinkle SN, Mumford SL, Grantz KL, Zhang C, Newman RB, Grobman WA, Albert PS, Sciscione A, Wing DA, Owen J, Chien EK, Buck Louis GM, Grewal J. Nutritional intake in dichorionic twin pregnancies: A descriptive analysis of a multisite United States cohort. Matern Child Health J. 2024 Feb;28(2):206-213. doi: 10.1007/s10995-023-03802-5. Epub 2023 Nov 7. PMID: 37934328.