About

Stefanie N. Hinkle, PhD, is an Assistant Professor of Biostatistics and Epidemiology at the University of Pennsylvania's Perelman School of Medicine. She serves as the Associate Director of Resident and Fellowship Research in the Department of Obstetrics and Gynecology. Dr. Hinkle is a faculty member at several research centers, including the Penn Center for Nutritional Science and Medicine (PenNSAM), the Center for Clinical Epidemiology and Biostatistics (CCEB), the Penn Skin Biology and Disease Resource-based Center (SBDRC), and the Diabetes Research Center (DRC) within the Institute for Diabetes, Obesity, and Metabolism (IDOM). She is also a core faculty member at the Penn Center on Food and Nutrition Policy and a founding member of the Center for Health Innovations in Reproductive and Perinatal Population Research (CHIRP). Her research focuses on maternal health, pregnancy complications, long-term mortality, and food insecurity during pregnancy, utilizing epidemiological and biostatistical methods to investigate health outcomes related to pregnancy and reproductive health.

Research topics

• Internal medicine
• Obstetrics
• Medicine
• Endocrinology

Selected publications

• Exploring Effect Modification by Obesity in Associations of Iron Deficiency with Fecundability After Pregnancy Loss

  Epidemiology · 2026-04-01

  article
  PublisherDOI

• Food insecurity with and without nutrition security: an exploratory analysis of the co-occurrence of food and nutrition (in)security

  Figshare · 2026-04-22

  articleOpen accessSenior author

  This analysis sought to explore the paradoxical co-occurrence of food insecurity without nutrition insecurity using cross-sectional survey data from 184 adults that completed the US Department of Agriculture food security questionnaire and a one-item potential indicator of nutrition security. Compared to those with food and nutrition insecurity, those with food insecurity without nutrition insecurity enrolled in more nutrition assistance (64% <i>v</i>. 41%) and food pantry or community fridge (57% <i>v</i>. 21%) programs and did most of their shopping at grocery rather than convenience stores (97 v. 59%). Future research should elucidate the temporal sequence of food and nutrition insecurity experiences.

  PublisherDOI

• Preconception <i>Mycoplasma genitalium</i> Seropositivity and Risk of Impaired Fecundity

  medRxiv · 2026-03-04

  articleOpen access

  Abstract Background Mycoplasma genitalium (MG) is an emerging sexually transmitted infection (STI) associated with pelvic inflammatory disease and tubal factor infertility. Its relationship with impaired fecundity remains unclear and is rarely examined in the context of co-seropositivity with other STIs. Methods We conducted a secondary analysis of the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial, a prospective preconception cohort of women with proven fecundity and prior pregnancy loss. MG serostatus was determined using Western blot–based IgG assays on 1146 stored serum specimens. Chlamydia trachomatis (CT) and other STIs were also measured. Associations between MG seropositivity and measures of impaired fecundity were assessed. Pregnancy loss and live birth were modeled using inverse-probability weighted quasi-Poisson and unweighted log-binomial models to calculate relative risks (RR). Fecundability-odds-ratio (FOR) was estimated using a discrete Cox proportional hazards model accounting for left truncation and right censoring. Propensity score (PS) weighted versions of these models assessed risks associated with CT co-seropositivity. Analyses were adjusted for demographic and reproductive history variables. Results Overall, 17.1% (n=210) of participants were MG seropositive, with 27.6% (n=58) co-seropositive with CT . Compared to STI-seronegative women, MG seropositivity was not associated with any outcome, although trends were observed for reduced fecundability (FOR adj : 0.87, 95% CI 0.70-1.08) and live birth (RR adj : 0.94, 95% CI 0.79-1.11). Co-seropositivity with CT was associated with lower likelihood of live birth [Relative Risk (RR) PS-weighted : 0.82, 95% CI: 0.70-0.96]. Sensitivity analyses supported the robustness of these findings. Conclusions Being co-seropositive for MG and CT preconception may impair fecundity.

  PublisherOA PDFDOI

• Food insecurity with and without nutrition security: an exploratory analysis of the co-occurrence of food and nutrition (in)security

  Journal of Hunger & Environmental Nutrition · 2026-04-21

  articleOpen accessSenior authorCorresponding
  PublisherDOI

• Target Trial Emulation for Non-Pharmaceutical Interventions: Methodological Challenges and Solutions

  Current Epidemiology Reports · 2026-05-12

  articleOpen access

  Abstract Purpose of Review Target trial emulation is a methodological framework designed to emulate hypothetical randomized controlled trials using observational data, particularly when conducting actual trials is unethical or infeasible. Non-pharmaceutical interventions, such as dietary patterns, physical activity, and environmental exposures, require unique methodological considerations for target trial emulation compared to pharmaceutical interventions. In this review, we aim to familiarize researchers with the key methodological challenges involved in emulating target trials of non-pharmaceutical interventions and to offer evidence-based recommendations for addressing these challenges. Recent Findings We outline the fundamental assumptions necessary for valid causal inference when emulating a target trial: consistency, exchangeability, and positivity. We examine why these assumptions are particularly challenging to uphold for non-pharmaceutical interventions compared to pharmaceutical exposures. Next, we review recent work on non-pharmaceutical interventions studied using target trial emulation and highlight five methodological challenges that threaten the validity of causal assumptions: ill-defined interventions, intervention heterogeneity, uncommon or infeasible strategies, unclear time zero, and periodic measurement with sustained adherence assumptions. We map each challenge to specific components of the target trial protocol. To demonstrate how these challenges manifest in practice, we present a case study of maternal dairy intake and risk of child allergies and conclude with practical recommendations for mitigating each challenge. Summary The framework and strategies outlined in this review will enable researchers to rigorously apply target trial emulation to non-pharmaceutical interventions, shifting the focus from documenting associations to estimating causal effects and strengthening the role of observational research in guiding evidence-based population health research.

  PublisherOA PDFDOI

• Food insecurity with and without nutrition security: an exploratory analysis of the co-occurrence of food and nutrition (in)security

  Figshare · 2026-04-22

  articleOpen accessSenior author

  This analysis sought to explore the paradoxical co-occurrence of food insecurity without nutrition insecurity using cross-sectional survey data from 184 adults that completed the US Department of Agriculture food security questionnaire and a one-item potential indicator of nutrition security. Compared to those with food and nutrition insecurity, those with food insecurity without nutrition insecurity enrolled in more nutrition assistance (64% <i>v</i>. 41%) and food pantry or community fridge (57% <i>v</i>. 21%) programs and did most of their shopping at grocery rather than convenience stores (97 v. 59%). Future research should elucidate the temporal sequence of food and nutrition insecurity experiences.

  PublisherDOI

• Social deprivation, race, and metabolic syndrome in patients with polycystic ovary syndrome

  Journal of the Endocrine Society · 2026-03-06

  articleOpen access

  Context: Social determinants of health (SDoH) are a key contributor to cardiovascular disease (CVD) risk, including metabolic syndrome (MetSyn), as well as racial disparities in that risk. It is unknown if SDoH are associated with MetSyn in women with polycystic ovary syndrome (PCOS), who have a high risk of CVD. Furthermore, it is unclear if SDoH contributes to the Black-White disparity in MetSyn among women with PCOS. Objective: To assess the association between the Social Deprivation Index (SDI; a proxy for SDoH) and the development of new-onset MetSyn in women with PCOS and whether SDI plays a role in the racial disparity in MetSyn. Design: Longitudinal cohort study. Setting: Tertiary care center. Patients or Other Participants: Women with hyperandrogenic PCOS and 2+ assessments for MetSyn 3 years apart. Interventions: None. Main Outcome Measures: Development of new-onset MetSyn; proportion of association between race and MetSyn attributable to SDI. Results: Two hundred twenty-two participants were followed for a median of 7 years; 43.7% developed new-onset MetSyn. High SDI, indicating greater social deprivation, was associated with an increased risk of developing MetSyn (adjusted relative risk 1.42, 95% confidence interval 1.07-1.91 adjusting for age), as was Black race. The proportion of the association between race and new-onset MetSyn explained by SDI was 21%. Conclusion: High social deprivation is associated with increased risk of new-onset MetSyn and may contribute to the higher risk in Black compared to White women with PCOS. These results highlight the importance of considering SDoH, particularly in an already high-risk population.

  PublisherDOI

• Weight Change Between Pregnancies and Mortality Over 50 Years of Follow‐Up

  Obesity · 2026-05-20

  articleOpen accessSenior author

  OBJECTIVE: This study aimed to evaluate the link between postpartum weight retention (PPWR) and long-term mortality. METHODS: In this secondary analysis of 8165 women with ≥ 2 pregnancies in the Collaborative Perinatal Project (CPP), U.S., 1959-1966, with vital status follow-up through 2016, we used interconception weight change (ICWC) and interpregnancy weight change (IPWC) as proxies of PPWR. ICWC was defined as the difference between self-reported pre-pregnancy weight from the 1st and 2nd CPP pregnancies, while IPWC was the difference between weight recorded at delivery of the 1st and pre-pregnancy weight of the 2nd CPP pregnancies. All-cause and cause-specific mortality models were adjusted for sociodemographic, behavioral, clinical, and pregnancy-related characteristics from the 1st CPP pregnancy. RESULTS: Compared to women with ICWC > 0 to 1.8 kg (quintile 3), those with ICWC > -1.4 to 0 kg (quintile 2) had a lower risk of all-cause mortality (aHR [95% CI]: 0.85 [0.76-0.96]), with the most notable reduction observed in diabetes-related risk of mortality (aHR [95% CI]: 0.45 [0.23-0.87]). Lower quintiles of IPWC (i.e., greater weight loss) were suggestive of reduced all-cause and cause-specific risk of mortality, though the estimates were not statistically significant. CONCLUSIONS: Minimizing PPWR was linked to reduced mortality risk over 50 years of follow-up.

  PublisherDOI

• Elevated lipid levels and altered semen parameters in men of couples seeking fertility care

  American Journal of Epidemiology · 2026-05-12

  article

  Elevated lipid levels may adversely impact sperm quality, raising concerns about infertility, amid the rising prevalence of cardiometabolic disease. However, evidence on associations between elevated lipids and semen quality parameters is limited, with the need for real-world studies. We examined this association using data from the Folic Acid and Zinc Supplementation Trial (FAZST), a double-blind, placebo-controlled, block-randomized trial from 2013-2017. We included 2321 males (≥18 years) in couples seeking infertility treatment who completed baseline questionnaires and provided blood and semen samples. We examined associations between elevated lipid levels, and semen volume, concentration, morphology, count, and total motility at baseline and 6-months, and DNA fragmentation at 6-months. Generalized linear and log-binomial models with inverse probability of treatment and selection weights were used to address confounding and losses-to-follow-up. At baseline, 1343 (57.9%) men had elevated lipid levels, with a higher likelihood of increased BMI, comorbidity burden, and male factor infertility. In baseline-adjusted linear models, men with elevated lipid levels had reduced semen volume and altered morphology. Reductions in sperm concentration and count were observed, but imprecise. Similar patterns were observed at 6-months, including reduced total motility. These findings suggest that elevated lipid levels may negatively affect semen quality and fertility.

  PublisherDOI

• Results of integrating an automated electronic social determinants of health screening survey in a gynecologic oncology practice: a pilot study

  International Journal of Gynecological Cancer · 2026-02-25

  article
  PublisherDOI

Frequent coauthors

• Cuilin Zhang

  351 shared

• Katherine L. Grantz

  221 shared

• Paul S. Albert

  170 shared

• Shristi Rawal

  115 shared

• Yeyi Zhu

  Kaiser Permanente

  112 shared

• Mengying Li

  Jiujiang First People's Hospital

  111 shared

• Pauline Mendola

  University at Buffalo, State University of New York

  106 shared

• Lindsey A. Sjaarda

  National Institutes of Health

  103 shared

Labs

• Hinkle LabPI

Education

• PhD, Nutrition and Health Science

  Emory University

  2012

Awards & honors

• Core Faculty, Penn Center on Food and Nutrition Policy, Univ…
• Founding Member, Center for Health Innovations in Reproducti…