About

Lisa D. Levine, M.D., M.S.C.E., is a Professor of Obstetrics and Gynecology at the Hospital of the University of Pennsylvania. She is an attending physician in Maternal Fetal Medicine at Pennsylvania Hospital and the Hospital of the University of Pennsylvania. Dr. Levine is a member of the Center for Research in Reproduction and Women's Health and the Institute for Translational Medicine and Therapeutics at the University of Pennsylvania. She also serves as an Associate Scholar at the Center for Clinical Epidemiology and Biostatistics and is the Director of the Pregnancy and Heart Disease Program at the Perelman School of Medicine. Her educational background includes a Bachelor of Arts in Chemistry/Pre-med from the College of the Holy Cross, an MD from Albert Einstein College of Medicine, and a Master of Science in Clinical Epidemiology from the Perelman School of Medicine at the University of Pennsylvania. Dr. Levine's research focuses on obstetrics and gynecology, with particular emphasis on maternal-fetal medicine, pregnancy-related cardiovascular risks, labor induction, cesarean risk prediction, and racial disparities in obstetrical outcomes. She has contributed to numerous studies and publications in these areas, advancing understanding and clinical practices related to pregnancy health and maternal outcomes.

Research topics

• Medicine
• Internal medicine
• Biology
• Endocrinology
• Andrology
• Immunology
• Biochemistry
• Obstetrics
• Intensive care medicine

Selected publications

• Omega-3 supplementation in addition to prenatal vitamins during pregnancy is associated with lower rates of preterm birth and small for gestational age

  Frontiers in Nutrition · 2026-01-06

  articleOpen access

  Omega-3 fatty acids and prenatal vitamins support fetal growth, but most studies assess omega-3 supplementation without accounting for baseline prenatal vitamin use during pregnancy. In this secondary analysis, we obtained data from the large, prospective Nulliparous Mother-to-be (nuMoM2b) cohort study of 9,461 nulliparous individuals. Participants were enrolled through eight clinical sites across the United States. We compared adverse birth outcomes between those taking additional omega-3 supplements beyond standard prenatal vitamin intake (PNV-OM) vs. prenatal vitamins alone (PNV). PNV-OM intake was associated with significantly lower rates of preterm birth (5.04 vs. 8.41%, P < 0.001) and SGA (2.84 vs. 4.48%, P = 0.004). After adjustment for demographic and clinical differences, PNV-OM use remained associated with reduced odds of preterm birth (aOR 0.64, 95% CI: 0.47–0.86, P = 0.004) and SGA (aOR 0.64, 95% CI: 0.42–0.95, P = 0.03). However, given substantial socioeconomic differences between groups and the potential for residual confounding, these findings should be interpreted with caution. Supplemental omega-3 intake during pregnancy may provide an additive benefit beyond prenatal vitamins alone, but randomized trials are needed to determine whether this relationship is causal.

  PublisherOA PDFDOI

• Pharmacy deserts and adverse pregnancy outcomes

  American Journal of Obstetrics and Gynecology · 2025-11-11

  articleOpen access
  PublisherDOI

• A Conversational Agent Using Natural Language Processing for Postpartum Care for New Mothers: Development and Engagement Analysis

  JMIR AI · 2025-04-22 · 3 citations

  articleOpen accessSenior author

  Background: The "fourth trimester," or postpartum time period, remains a critical phase of pregnancy that significantly impacts parents and newborns. Care poses challenges due to complex individual needs as well as low attendance rates at routine appointments. A comprehensive technological solution could provide a holistic and equitable solution to meet care goals. Objective: This paper describes the development of patient engagement data with a novel postpartum conversational agent that uses natural language processing to support patients post partum. Methods: We report on the development of a postpartum conversational agent from concept to usable product as well as the patient engagement with this technology. Content for the program was developed using patient- and provider-based input and clinical algorithms. Our program offered 2-way communication to patients and details on physical recovery, lactation support, infant care, and warning signs for problems. This was iterated upon by our core clinical team and an external expert clinical panel before being tested on patients. Patients eligible for discharge around 24 hours after delivery who had delivered a singleton full-term infant vaginally were offered use of the program. Patient demographics, accuracy, and patient engagement were collected over the first 6 months of use. Results: A total of 290 patients used our conversational agent over the first 6 months, of which 112 (38.6%) were first time parents and 162 (56%) were Black. In total, 286 (98.6%) patients interacted with the platform at least once, 271 patients (93.4%) completed at least one survey, and 151 (52%) patients asked a question. First time parents and those breastfeeding their infants had higher rates of engagement overall. Black patients were more likely to promote the program than White patients (P=.047). The overall accuracy of the conversational agent during the first 6 months was 77%. Conclusions: It is possible to develop a comprehensive, automated postpartum conversational agent. The use of such a technology to support patients postdischarge appears to be acceptable with very high engagement and patient satisfaction.

  PublisherDOI

• QUANTIFYING THE POTENTIAL IMPACT OF MATERNAL CARDIOVASCULAR HEALTH ON PREVENTION OF ADVERSE PREGNANCY OUTCOMES

  American Journal of Preventive Cardiology · 2025-09-01

  articleOpen access

  CVD Prevention – Primary and Secondary More favorable maternal cardiovascular health (CVH) is associated with lower risk of adverse pregnancy outcomes (APOs). However, estimates of the potential impact of improving maternal CVH on the burden of APOs are not available. We sought to estimate the proportion of APOs that could be prevented if the population distribution of maternal CVH was improved. Pregnant participants aged ≥ 18 years enrolled in the Nulliparous Pregnancy Outcomes Study (nuMoM2b) without pre-pregnancy hypertension or diabetes were included in analyses. First trimester CVH was assessed using six-factors from the Life’s Essential 8 framework (physical activity, diet, sleep, nicotine use, body mass index, and blood pressure). CVH was scored from 0-100 with higher scores representing better CVH. APOs included new-onset hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), and preterm birth (<37 weeks gestation, PTB). The primary outcome was incidence of any APO and secondary outcomes included each APO separately. Logistic regression models assessed the association of early pregnancy CVH and APOs. Impact fractions were calculated to estimate the proportion of APOs that could be prevented if maternal CVH was improved for those with the lowest CVH scores. A priori selected covariates of study site, maternal age, insurance type, and depressive symptoms at baseline were included in analyses. Among the 8927 pregnant participants included, 25.3% experiencing an APO. A lower total CVH score was associated with a significantly higher risk of the composite APO outcome. An estimated 12% of APOs would be prevented if a hypothetical intervention shifted all participants with a CVH score <50 to a score of 50 (5.8% of participants). Moreover, a dose-response relationship was observed with 15% and 40% of APOs estimated to prevented if a hypothetical intervention shifted participants with a CVH score <80 to 80 points (51.4% of participants) or shifted everyone to 100 points (96.6% of participants), respectively ( Figure 1 ). Similar findings were observed for each APO type. In this cohort of nulliparous pregnant individuals, estimated potential benefits of improving maternal CVH to reduce APOs are considerable. Determining efficacious and equitable strategies to improve CVH pre-pregnancy or early pregnancy period are needed.

  PublisherDOI

• A novel two-sample Mendelian randomization framework integrating common and rare variants: application to assess the effect of HDL-C on preeclampsia risk

  medRxiv · 2025-08-24

  preprintOpen access

  Mendelian randomization (MR) has become an important technique for establishing causal relationships between risk factors and health outcomes. By using genetic variants as instrumental variables, it can mitigate bias due to confounding and reverse causation in observational studies. Current MR analyses have predominantly used common genetic variants as instruments, which represent only part of the genetic architecture of complex traits. Rare variants, which can have larger effect sizes and provide unique biological insights, have been understudied due to statistical and methodological challenges. We introduce MR-CARV, a novel framework integrating common and rare genetic variants in two-sample Mendelian randomization. This method leverages comprehensive genetic data made available by high-throughput sequencing technologies and large-scale consortia. Rare variants are aggregated into functional categories, such as gene-coding, gene-noncoding, and non-gene regions, by leveraging variant annotations and biological impact as weights. The effects of rare variant sets are then estimated with STAARpipeline and combined with the estimated effects of common variants by the existing MR methods. Simulation studies demonstrate that MR-CARV maintains robust type I error and achieves higher statistical power, with up to a 66.3% relative increase compared to existing methods only based on common variants. Consistent with these findings, application to real data on HDL-C and preeclampsia showed that MR-CARV(IVW) yielded a more precise and statistically significant effect estimate (-0.021, SE = 0.0101, P = 0.0365) than IVW using only common variants (-0.024, SE = 0.0123, P = 0.0538).

  PublisherOA PDFDOI

• Adverse Pregnancy Outcomes and N-Terminal Pro-Brain Natriuretic Peptide Levels 2 to 7 Years After Delivery

  JAMA Cardiology · 2025-04-04 · 4 citations

  articleOpen access

  This cohort study examines the association of adverse pregnancy outcomes and N-terminal pro-brain natriuretic peptide levels years after delivery.

  PublisherOA PDFDOI

• Association Between COVID-19 During Pregnancy and Preterm Birth by Trimester of Infection: Retrospective Cohort Study Using Large-Scale Social Media Data

  Journal of Medical Internet Research · 2025-07-09 · 1 citations

  articleOpen access

  Background: Preterm birth, defined as birth at <37 weeks of gestation, is the leading cause of neonatal death globally and the second leading cause of infant mortality in the United States. There is mounting evidence that COVID-19 infection during pregnancy is associated with an increased risk of preterm birth; however, data remain limited by trimester of infection. The ability to study COVID-19 infection during the earlier stages of pregnancy has been limited by available sources of data. Objective: The objective of this study was to use self-reports in large-scale social media data to assess the association between the trimester of COVID-19 infection and preterm birth. Methods: In this retrospective cohort study, we used natural language processing and machine learning, followed by manual validation, to identify self-reports of pregnancy on Twitter and to search these users' collection of publicly available tweets for self-reports of COVID-19 infection during pregnancy and, subsequently, a preterm birth or term birth outcome. Among the users who reported their pregnancy on Twitter, we also identified a 1:1 age-matched control group, consisting of users with a due date before January 1, 2020-that is, without COVID-19 infection during pregnancy. We calculated the odds ratios (ORs) with 95% CIs to compare the frequency of preterm birth for pregnancies with and without COVID-19 infection and by the timing of infection: first trimester (1-13 weeks), second trimester (14-27 weeks), or third trimester (28-36 weeks). Results: Through August 2022, we identified 298 Twitter users who reported COVID-19 infection during pregnancy, a preterm birth or term birth outcome, and maternal age: 94 (31.5%) with first-trimester infection, 110 (36.9%) with second-trimester infection, and 95 (31.9%) with third-trimester infection. In total, 26 (8.8%) of these 298 users reported preterm birth: 8 (8.5%) with first-trimester infection, 7 (6.4%) with second-trimester infection, and 12 (12.6%) with third-trimester infection. In the 1:1 age-matched control group, 13 (4.4%) of the 298 users reported preterm birth. Overall, the odds of preterm birth were significantly higher for pregnancies with COVID-19 infection compared to those without (OR 2.08, 95% CI 1.06-4.28; P=.046). In particular, the odds of preterm birth were significantly higher for pregnancies with COVID-19 infection during the third trimester (OR 3.16, 95% CI 1.36-7.29; P=.007). The odds of preterm birth were not significantly higher for pregnancies with COVID-19 infection during the first trimester (OR 2.05, 95% CI 0.78-5.08; P=.12) or second trimester (OR 1.50, 95% CI 0.54-3.82; P=.44) compared to those without infection. Conclusions: Based on self-reports in large-scale social media data, the results of our study suggest that COVID-19 infection particularly during the third trimester is associated with higher odds of preterm birth.

  PublisherDOI

• Subclinical Cardiac Dysfunction in Women With Prior Gestational Diabetes: The Hispanic Community Study/Study of Latinos

  Journal of the American Heart Association · 2025-10-21 · 2 citations

  articleOpen access

  BACKGROUND: Gestational diabetes (GD) is associated with heart failure risk. However, the association of GD and postpartum early stages of myocardial dysfunction (a robust predictor of heart failure) as assessed by imaging has seldom been examined, especially among Hispanic women, who represent the fastest-growing ethnic minority population and have the highest prevalence of GD in US women. METHODS: We examined Hispanic women recruited to the Hispanic Community Study/Study of Latinos cohort, who reported at least 1 prior pregnancy and GD history at either visit 1 (2008-2011) or visit 2 (2014-2017) and echocardiographic assessments at visit 2. We used multivariable linear and logistic regression models to evaluate the associations between GD history and echocardiographic parameters. RESULTS: Among 2894 participants (mean age 53±9 years), 9.3% (n=270) had a GD history. After adjusting for cardiovascular disease risk factors, including current diabetes status, Hispanic women with GD history had higher mean adjusted left ventricular relative wall thickness (β=0.01 [95% CI, 0.00-0.02]), lateral peak early mitral inflow velocity to early diastolic velocity of the mitral annulus ratio (β=0.49 [95% CI, 0.09-0.89]), abnormal left ventricular diastolic function (adjusted odds ratio, 1.41 [95% CI, 1.04-1.91]), and lower mean adjusted left ventricular end-diastolic diameter (β=-0.07 [95% CI, -0.12 to -0.02]) compared with those without prior GD history. Similar associations were observed in results stratified by the most recent glycemic status. CONCLUSIONS: History of GD was associated with a higher frequency and severity of myocardial diastolic abnormalities. Echocardiographic-based screening for myocardial dysfunction in women with GD history has the potential to help avert overt cardiovascular disease in this high-risk population.

  PublisherDOI

• The impact of implementing a standardized protocol for labor induction on obstetric disparities: Secondary analysis of a type I hybrid effectiveness‐implementation trial

  DOAJ (DOAJ: Directory of Open Access Journals) · 2025-07-01

  articleOpen accessSenior author

  Abstract Introduction Prior retrospective data demonstrated that standardization of labor induction may reduce racial disparities in cesarean delivery and morbidity. Here, we aimed to determine the impact of prospectively implementing an induction protocol on racially disparate outcomes. Methods This was a planned secondary analysis of a type I hybrid effectiveness‐implementation trial comparing 2 years before (PRE) and 2 years after (POST) implementation of a standardized induction protocol at two labor units (2018 to 2022). The protocol had eight components and recommended active induction management, frequent cervical exams, and amniotomy by first exam ≥4 cm. All singleton pregnancies ≥37 weeks with intact membranes requiring cervical ripening were eligible; prior cesarean delivery was excluded. Data were collected via individual chart review. This analysis included only those with self‐identified race, divided into Black, Indigenous, People of Color (BIPOC), and white. Poisson regression with interaction terms evaluated the protocol's impact on disparities in cesarean delivery and morbidity. Fidelity to the protocol was defined as adherence to ≥75% of the eight protocol components. Results A total of 8386 patients were included (PRE = 4167; POST = 4219); 59.3% were identified as BIPOC. BIPOC patients differed in delivery site, insurance, body mass index, parity, age, diagnosis of diabetes and hypertension, gestational age, and induction indication. BIPOC patients were more likely to undergo cesarean in the PRE (aRR 1.36[1.18–1.58]) period, and remained more likely to undergo cesarean POST‐implementation (aRR 1.55[1.33–1.70]), even when controlling for differences between groups. Similarly, maternal morbidity was greater among BIPOC patients PRE‐implementation (aRR 1.25[1.07–1.46]) and remained greater among BIPOC patients POST‐implementation (aRR 1.34[1.14–1.58]). There was no difference by race/ethnic group in neonatal morbidity in either PRE or POST. Finally, the protocol was implemented similarly by BIPOC versus white. Conclusion Despite uniform implementation of a standardized induction protocol across race/ethnic groups, this intervention did not mitigate observed racial disparities in cesarean or maternal morbidity.

  PublisherDOI

• Developing a novel patient-centered definition of severe maternal morbidity

  American Journal of Obstetrics & Gynecology MFM · 2025-05-25 · 1 citations

  articleSenior author
  PublisherDOI

Recent grants

• Cardiovascular Risk after Preeclampsia - The CRISP study

  NIH · $740k · 2018–2021

Frequent coauthors

• William A. Grobman

  The Ohio State University

  575 shared

• Lynn M. Yee

  Northwestern University

  553 shared

• Anthony Sciscione

  527 shared

• Jay D. Iams

  Eunice Kennedy Shriver National Institute of Child Health and Human Development

  526 shared

• Amy Turitz

  Greenwich Hospital

  525 shared

• Tetsuya Kawakita

  Eunice Kennedy Shriver National Institute of Child Health and Human Development

  524 shared

• Tracey C. Fleischer

  523 shared

• Dean V. Coonrod

  Healthwise

  523 shared

Labs

• Levine LabPI

Awards & honors

• Women’s Reproductive Health Research Award
• Leonard Davis Institute of Health Economics Senior Fellow
• Division Chief, Maternal Fetal Medicine Division, University…