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From AI to ICG: The Future of Endometriosis Diagnosis and Treatment

Endometriosis specialist Dr. Xiaoming Guan is working with a team of researchers to expedite the diagnosis of this painful disease through artificial intelligence (AI), preventing years of suffering as women search for relief.

“Currently, the use of MRI for diagnosing endometriosis can pose challenges, particularly in smaller centers where expertise may be limited,” said Dr. Guan, professor of obstetrics and gynecology at Baylor, fellowship director and chief of the division of Minimally Invasive Gynecologic Surgery.

“Using artificial intelligence based on an analysis of MRI imaging from confirmed cases, we’re developing an initial screening system that would scan a patient’s MRI and then indicate the likelihood they have endometriosis. In the future the system could also hopefully stage the disease and predict things like bowel endometriosis, endometrioma, and pelvic adhesions to help us determine other specialties needed during surgery.” Today, endometriosis can only be confirmed through laparoscopic surgery and biopsy.

As co-investigator, Dr. Guan is identifying the patients and MRI imaging needed to create the algorithm for the AI-based system, pulling from hundreds of cases he’s treated over the years.

A recognized leader in endometriosis excision surgery, Dr. Guan was recently elected to the board of the American Association of Gynecologic Laparoscopists (AAGL). “It’s a big deal to me,” he admitted, “and an honor to serve the largest organization supporting my field. With thousands of members from 110 countries, it’s also an opportunity to make a global impact on endometriosis through basic scientific research, training, and increased awareness of innovative approaches.”

He is one of the few surgeons in the world performing novel procedures like . “We’ve performed close to 200 surgeries now, transvaginally removing all of the endometriosis,” said Dr. Guan. “Research shows this approach leads to less pain, faster recovery, and fewer pelvic adhesions compared to a transabdominal approach.”

The surgery can be technically challenging, he noted, requiring expertise in both endometriosis surgery and Natural Orifice Transluminal Endoscopic Surgery (NOTES). “I hope to provide training to help others use this approach so more patients around the world can benefit.”

“Anything that can benefit endometriosis patients, I'm willing to help,” said Dr. Guan.

In another published study, Dr. Guan used a new ICG (indocyanine green) robotic Firefly technique to reduce complications and surgical time in a complex stage 4 endometriosis case. The study found that using this fluorescent green dye enabled the team to quickly identify endometriosis tissue and reduced the risk of urethral and bowel injury during a robotic-assisted transvaginal NOTES hysterectomy with endometriosis resection. 

Inventing the Future of Fetal Surgery

Dr. Michael Belfort has an impressive history of moving the field of fetal surgery forward through innovation, both in the procedures he performs and in the devices he develops that make them possible.

“One of the major innovations we developed here is the use of humidified and heated carbon dioxide inside the uterus,” said Dr. Belfort. Designed to protect the fetal membranes from drying out during surgery and becoming damaged, the system has changed fetal surgery around the world. 

He keeps a book on his desk with all of his ideas and drawings in it. “When an issue comes up, I try and design something to address it. Then I try and find someone to make it,” he added, a challenge given the small market for these devices. 

To perform their groundbreaking 2-port fetoscopic neural tube defect (NTD) repair, a defect that occurs when the fetal spine doesn’t close properly, he turned to a jeweler for help modifying existing scopes for use inside the uterus. “Working in such a small space requires miniaturizing current instruments and developing new devices that do multiple jobs at the same time,” explained Dr. Belfort. 

New tools in the works include a miniaturized device to prevent the fetoscopic lens from fogging up, miniaturized sensors to continuously monitor the fetal heart rate, and TinyStitch, a device to simplify suturing, shortening procedures. 

In collaboration with Rice University and Catholic University of Leuven in Belgium, he’s developing a nanopatch that is hydrophilic on one side and hydrophobic on the other to prevent the spinal cord from growing into the overlying tissue following an NTD repair. 

“We have an NIH Grant to develop a ChorioAnchor, a tiny device that will secure the chorioamniotic membranes to the uterine wall, preventing them from separating and causing amniotic fluid leakage,” added Dr. Belfort. 

He’s creating a “Lincoln” needle, named after a former patient, for use in cutting a hole in a membrane inside the fetal heart to treat hypoplastic left heart syndrome with intact interstitial septum. 

Also in development is a fetoscopic technique to close gastroschisis – an opening in the fetal abdomen that allows the baby’s intestines to float in the amniotic fluid. 

“Today we’re looking at the uterus as a new operating space and evaluating other conditions where surgery prior to birth could provide life-saving or life-improving benefits for these babies,” he said. 

Welcoming a Leading Mind in Reproductive Medicine

Dr. Laura Detti is a self-described “why” person with a passion for research.

“I like to understand the ‘why’ of everything. That’s what brought me here,” said Baylor’s new director of Reproductive Endocrinology and Infertility. “I was attracted to the incredible research going on at one of the few real academic centers left in the country.”

Over the past decade, Dr. Detti’s research has focused primarily on . Her interest in the mechanisms and causes of fertility loss has led to a new understanding of a during cancer treatment. She was among the first to study this anti-Müllerian hormone (AMH) in a .

“Today we’re working on a new molecule that can mimic the actions of AMH at a fraction of the cost,” said Dr. Detti, a professor in the department of Obstetrics and Gynecology.

Ultrasound is another main interest, including published research on the use of ultrasound to predict a future miscarriage as early as the sixth week. “We found that with we could predict a miscarriage ,” she explained.

“We’re also working on using ultrasound to assess tubal patency, or blocked fallopian tubes, rather than using hysterosalpingogram (HSG). With tubal patency ultrasounds we’re able to see whether the woman can get pregnant naturally or needs to undergo IVF because the tubes are blocked.”

An additional area of interest is the study of , a congenital anomaly, and its association with early pregnancy loss.

As division director, her plans include further development of the IVF program and Family Fertility Center and ongoing expansion of The Woodlands clinic.

“I’d also like for this division to become a national hub for fertility preservation in the pediatric population, helping patients who may not be able to have biological children when they grow up,” said Dr. Detti, chief of Reproductive Endocrinology Services at Texas Children’s Pavilion for Women. “With our research and the relationship between Baylor and Texas Children’s, we are uniquely positioned to achieve that.”

Another goal: to become a center of reference for difficult REI cases, advancing the understanding and treatment of complex reproductive disorders.

“Fertility is only the tip of the iceberg of what we do,” noted Dr. Detti. “We are here to treat the full spectrum of underlying endocrine problems.” Her research on polycystic ovary syndrome (PCOS) includes and another on .

When Preparation Meets Opportunity: A Path to Research in Women’s Health

When Preparation Meets Opportunity: A Path to Research in Women’s Health

For Dr. Julie Hakim, assistant professor in Baylor’s division of Pediatric and Adolescent Gynecology, the path to becoming a scientist and inventor has been anything but straight.

The twists and turns included leaving behind a pre-med major to pursue African studies, plans to join UNICEF, a rejected initial application to medical school, a year doing research, and an application to a French medical school, a language she barely spoke.

She got an interview.

“I had three months to figure out how to explain why they needed me in their francophone school and what would be their return on investing in me,” said Dr. Hakim. “It was then that I realized there are certain things I’ve always been good at or enjoyed, but never thought of as skill sets.”

Among them: storytelling and selling a vision she’s passionate about.

“So I went to that interview, sold them on my vision about why they needed me, and got in,” she said. “Then came the hard part – learning French and medicine at the same time. That led me to realize another theme in my life: I can do hard things that I’m passionate about.”

Like starting an orphanage in Kenya during medical school. Becoming a Pediatric Gynecology Fellow at Baylor. Creating her own research lab. And developing innovative medical devices.

“During my fellowship we saw patients developing scar tissue in their vaginal tract following reconstructive surgery. All we had to help them were makeshift vaginal stents,” said Dr. Hakim. “I kept thinking there has to be something better.”

“I didn't have a background in basic science, engineering, or business, but I had passion, a vision and a story to tell, so I decided I was going to create a device to help these patients heal.”

This month, she was issued a U.S. Patent on her designs. In April, that novel vaginal stent she envisioned is going to clinical trial.

“This is a fantastic institution for young people who have a desire to do more, think broadly, be outside the box, and create things that don't exist. There is enormous opportunity and potential here.”

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Reducing Acute Maternal Stress Caused by a Fetal Abnormality Diagnosis

Can a simple smartphone app provide pregnant women the help they need to cope with a fetal abnormality diagnosis?

It’s a question ����������� Maternal-Fetal Medicine specialist Dr. Roopali Donepudi hopes to answer through a new study underway at Texas Children’s Pavilion for Women.

“We know from a that pregnant women diagnosed with a fetal abnormality were found to have higher levels of anxiety and depression, and they may not be long term,” said Dr. Donepudi. “In many cases, patients may just need an intervention to help during that acute period of stress following their diagnosis or right after delivery, when they’re wondering what’s going to happen to their baby.”

“Our goal with this follow-up study is to see if there is a simple intervention we can offer that provides the care these high-risk patients need, when they need it,” she continued.

“We are so fortunate to have The Women’s Place – Center for Reproductive Psychiatry here to refer patients to, but for most women, accessing a therapist or psychiatrist isn’t easy. If we can find simpler tools to help these patients, it could have a major impact on women everywhere who are facing a fetal abnormality diagnosis.”

For their research, they wanted to start with a simple tool that was easily accessible and easy for patients to use, she noted. “Since most people have smartphones, we chose a meditation and mindfulness app, Expectful, designed specifically for pregnant women. We teamed up with the company to offer the app free to all study participants.”

The one-year study is open to pregnant women with a fetal abnormality who have their imaging, diagnosis, and delivery at .

The study will assess the intervention’s impact in three ways, as Dr. Donepudi explained.

“First, we’ll use a simple survey that patients complete throughout the course of their pregnancy and after delivery. Second, we’ll get immediate biofeedback on the mother’s heart rate variability before and after they use the mindfulness tool, to see how their body is responding. Third, we’ll use a small blood sample to assess serum biomarkers in the lab to see if the app is making an even deeper impact on stress levels.”

“There is a lot of awareness around mental health today, especially during pregnancy and postpartum,” added Dr. Donepudi, associate professor in the Department of Obstetrics and Gynecology and director of both the perinatal surgery and fetal intervention fellowship programs. “Our focus is on moving beyond screening and identifying needs, to finding immediate ways to help these patients.”

Engineering New Hope for Families Facing Fetal Abnormalities

During September 2021, Dr. Michael Belfort took another step forward in fetal surgery with the hiring of an in-house engineer, Dr. Kwon Soo Chun. The goal: to help his team develop the revolutionary devices needed to treat fetal abnormalities in the womb.

Dr. Chun earned his bachelor’s, master’s and a Ph.D. in mechanical engineering. “I’ve been working on medical devices since I was a Ph.D. student at Stanford University, where I designed and developed spinal implants,” said Dr. Chun. He also gained valuable experience in intellectual property protection, start-ups and academic spin-offs.

After graduation he joined Baylor’s cardiology team, working on pediatric heart valves at Texas Children’s Hospital. “I was the only engineer on a team that developed a new polymeric transcatheter heart valve for children,” he noted. “Our lab was awarded the NIH STTR Phase I grant, the SBIR Phase II grant, and seed funding from the Southwest National Pediatric Device Consortium.”  

While physicians and engineers usually “speak different languages,” Dr. Chun enjoys bridging the two roles. “I listen to doctors’ ideas, watch their cases, clarify their clinical needs, and then search what’s out there. What devices exist? What is the market? Are there IP issues? From there, we build a prototype and find funding to get it developed.”

His experience with grants will prove vital both for research funding as well as in the commercialization process. “Fetal devices have massive clinical relevance but few investors are interested in making them because the market is so small,” he explained.

As word spreads about his arrival in the Obstetrics and Gynecology department, Dr. Chun is in demand, meeting with physicians across the department to discuss new devices and how he can help engineer them.

His primary focus is fetal surgery, starting with Dr. Belfort’s septal puncture project, a device to create a hole in the septum between the right and left atrium of the fetal heart for treatment of hypoplastic left heart syndrome (HLHS) with intact interstitial septum.

A Growing Presence in Gynecologic Cancer Care and Research

Baylor’s gynecologic oncology team is making an impact in institutions across the Texas Medical Center, bringing specialized expertise and cutting-edge treatments to women facing cancers of the female reproductive system.
 
“As part of the Dan L Duncan Cancer Center, our practice and our presence continue to grow,” said Dr. Jan Sunde, division director of Gynecologic Oncology.
 
The Duncan Cancer Center, one of two NCI-designated Comprehensive Cancer Centers in Houston, is home to the unique treatments, innovative trials and promising research these centers are known for.
 
“We’re the only cancer center in Houston currently using hyperthermic intraperitoneal chemotherapy (HIPEC) to treat ovarian cancer,” Dr. Sunde noted. The treatment, which uses heated chemotherapy to bathe the lining of the abdomen during surgery, has shown to improve survival in select patients.
 
“We also offer a Hereditary Ovarian and Uterine Cancer Clinic, led by Dr. Claire Hoppenot, providing counseling for women genetically predisposed to these cancers to ensure they get the screening and preventative care they need,” added Dr. Sunde.
 
The division has an active research program including clinical trials, offering collaborative trials with NRG and Gynecologic Oncology Group Partners and BCM-only trials. Examples include the use of oral niraparib (chemotherapy) with radiation for cervical cancer; the use of immunotherapy drugs combined with chemotherapy or radiation for endometrial cancer; the impact of uterine manipulation during minimally invasive surgery on endometrial cancer recurrence; and the use of a new agent for platinum resistant ovarian cancer.
 
“Chemotherapy plus immunotherapy has become our first-line treatment for recurrent cervical cancer, plus we have a new agent for second line disease,” he noted. “We continue to study new ways to get the body’s immune system to fight cancer, and to design new trials to meet the diverse needs of the patients and healthcare settings we serve.”
 
Practice sites include Baylor St. Luke’s main campus and the McNair campus, where the Duncan Cancer Center site is located, Harris Health Ben Taub Hospital and Smith Clinic, and Texas Children’s Pavilion for Women.
 
In the lab, his studies on endometrial secretome (or secretory) factors that help benign gynecologic tissues implant and grow where they don’t belong – including endometriosis and endosalpingiosis – are paving the way for breakthroughs in cancer detection and prevention.

Clinical Trial Combines Therapies to Beat HPV Cancers Worldwide

A underway at ����������� offers promising treatment for women with gynecologic cancers previously considered incurable, including cervical, vaginal and vulvar cancers caused by human papillomavirus (HPV).

“If it proves effective, we have the potential to impact women’s health here in the United States and also worldwide since the medications are readily available,” said principal investigator Dr. Jan Sunde, director of gynecologic oncology at the Dan L Duncan Comprehensive Cancer Center and an associate professor in the department of Obstetrics and Gynecology at Baylor.

Historically, the standard treatment for cervical, vaginal and vulvar cancers has been chemotherapy and radiation, with immunotherapy recently added as a part of the treatment regimen, explained Dr. Sunde.

“In this trial, we combine that standard treatment with additional therapies that further stimulate and strengthen the immune system to help the body better fight these HPV-related cancers. The goal is to determine if this combined therapy is more effective than the standard treatment alone.”

The idea for the trial – and the funding that made it possible – started with a call he got for a second opinion.

“The patient had vulvar cancer with a 20-centimeter tumor,” said Dr. Sunde. “After the standard treatment of radiation plus chemo, her tumor shrunk to 10 centimeters. Surgery wasn’t possible given the size and location of the tumor so we talked about different options, including immunotherapy.”

“I remembered a by a colleague who treated two patients – one with vulvar cancer and one with cervical cancer – using HPV vaccines injected into their tumors and a topical cream, imiquimod, to stimulate the immune system. Their tumors completely resolved.”

“I sent the report to the patient and she decided to proceed with this alternative regimen, so we treated her with it,” said Dr. Sunde. “During the course of her treatment she said, ‘Wouldn’t it be great if other people could get this?’”

“Today, she is nearly two years out with no evidence of disease – the tumor disappeared. And she is funding this trial to see if it might help others benefit from the treatment. It’s pretty remarkable.”

Eligible candidates for the phase two drug trial include patients with cervical, vaginal or vulvar cancer that has spread.

All participants get their standard chemotherapy with radiation and immunotherapy treatment, plus three additional therapies: HPV L-I vaccinations in the tumor, imiquimod cream applied to the surface of the tumor, and oral metformin – all FDA-approved medications, with the aim of boosting the immune system.

“Unlike the case study, we’re starting the vaccines when the patient is getting radiation, to try and stimulate the immune system earlier,” he noted. “We’re also collecting swabs to examine the changes in the immune response and within the tumor microenvironment.”

“Immunotherapy is about getting the body to fight on its own and respond appropriately to the cancer. It’s been a big change in cancer therapy. Anecdotally, there are a number of patients who have done very well with this protocol. We need to wait and see what the two-year survival is,” said Dr. Sunde.

“If it improves outcomes, providers around the world – especially anywhere radiation is available – can start using the treatment immediately to help more women. Imagine the impact it could have globally, where HPV cancers are most prevalent. We could potentially extend the treatment to other HPV-induced cancers and tumor sites, including oropharyngeal cancer and anal cancers.”

An estimated 13,000 new cases of cervical cancer are diagnosed each year in the US, with some 4,000 women dying of this cancer. Worldwide approximately 300,000 women die from cervical cancer annually, with women from lower resource countries disproportionately affected.

“The cost of this treatment – using six HPV vaccinations plus the other therapies – is substantially less than a single immunotherapy treatment, making it much more accessible for patients worldwide than immunotherapy,” he added.

To refer a patient, contact Dr. Sunde at Jan.Sunde@bcm.edu or Keneshia Lane at Keneshia.Lane@bcm.edu or call 832-826-8071.

Advancing Prenatal Genetics and Patient Care

In collaboration with investigators around the world, Baylor continues to advance the complex field of prenatal genetics, improving the detection of genetic abnormalities in the fetus.

“The overarching goal of our research is to bring new technologies, screening and testing tools to improve prenatal diagnosis of genetic disorders and also to study the complexities of integrating those tools into patient care and their impact on outcomes,” said Dr. Ignatia Van den Veyver, professor of OB/GYN and Molecular and Human Genetics at Baylor.

Working together is essential to the progress being made, she emphasized.

“Today we’re part of a collaborative multicenter grant-funded study evaluating the role of trio whole genome sequencing in prenatal diagnosis of birth defects,” said Dr. Van den Veyver, a Co-PI for the PrenatalSEQ study. “For eligible women who participate in the ongoing clinical trial, we sequence the DNA of the fetus and both parents and study how the results impact the prenatal care and the care of the baby after birth. The trial investigators also study how going through sequencing affects the parents.”

“We’re also involved in projects to improve our collective ability to interpret prenatal sequencing results,” she continued.

Among those projects: a collaborative effort to standardize descriptions of prenatal phenotypes or physical features of certain conditions. Known as Human Phenotype Ontology, the information will help researchers around the world better compare findings from different studies.

“I am also co-chairing a new prenatal gene curation expert panel in ClinGen, a program aimed at building a central knowledgebase to inform precision medicine and research, to catalog which genes and sequence variants cause unique prenatal genetic disorders,” said Dr. Van den Veyver.

Her team also continues work on improving non-invasive prenatal testing by studying circulating fetal DNA and cells, drawing blood from the mother’s arm to detect genetic fetal abnormalities.

Collectively these and other studies help form the foundation for the emerging field of fetal precision medicine.

“More and more, we are beginning to individualize the care and the diagnostic approach of each pregnant woman who has a complicated pregnancy, where there are health issues in the fetus so that we can better tailor counseling and treatment during pregnancy and after birth,” said Dr. Van den Veyver.

Vascular Biology Behind Healthier Pregnancies and Babies

Dr. Chandrasekhar Yallampalli’s  is advancing our understanding of how the body’s vascular system adapts to pregnancy, providing new hope for the treatment and prevention of pregnancy complications for mothers and babies.

“During pregnancy, a woman’s blood volume increases by about 50 percent, without increasing blood pressure,” explained Dr. Yallampalli. “The body’s blood vessels relax and become less rigid to accommodate the increased blood volume. If we know what happens normally, we can better understand why and how these vascular adaptations sometimes fail, causing hypertension, preeclampsia and other prenatal conditions.”

This lifelong research focus was “completely serendipitous,” he noted. “Early in my career, the findings of a study I was doing on preterm labor failed to support my theory. It was my first grant. I was so disappointed – until I realized I’d stumbled upon a vascular adaptation. I wanted to learn more. Our  and I’ve been a vascular biologist ever since.”

Over the next 25 years, he and his team discovered some of the fundamental mechanisms of vascular adaption. The grant for these studies has been continuously funded since 1997.

“Today we’re examining the role of complement, part of the body’s immune system, in causing preeclampsia, with the hope of developing therapies to prevent the hypertension and preterm delivery associated with this complication,” he explained.

“We’re also studying fetal programming of adult health, specifically how a low-protein diet during pregnancy results in a fetus ‘hard-wired’ to develop adult hypertension and diabetes. It’s important for pregnant women or those planning to become pregnant to understand that with good nutrition, including sufficient protein, they can give their child the gift of good health.”

His third research focus is gestational diabetes and understanding the mechanisms causing the abnormal amount of lipids in the mother’s blood, which travel across the placenta causing a large baby with long-term health issues.

����������� and Texas Children’s Hospital Join RAFT Trial

����������� has joined the multicenter , a clinical study aimed at improving fetal lung function and newborn survival in patients with early pregnancy renal anhydramnios (EPRA).  

“In pregnancies with renal anhydramnios, there is no amniotic fluid around the baby,” explained Baylor Medicine fetal specialist Dr. Magdalena Sanz Cortes. “This experimental therapy involves a series of fluid injections into the womb, known as amnioinfusions. Without fluid, the fetal lungs are underdeveloped and the baby isn’t able to survive at birth due to respiratory insufficiency,” said Dr. Sanz Cortes. 

Renal anhydramnios occurs when problems with the fetal kidneys prevent the fetus from producing urine. After 16 to 18 weeks of pregnancy, amniotic fluid is composed primarily of fetal urine.  

“The primary objective of the study is to help the fetal lungs grow enough so the newborn can survive for 14 days after birth and have access to dialysis,” said Dr. Sanz Cortes.  

Patients referred to the Texas Children’s Fetal Center team are assessed to determine if they meet the trial’s. Eligible patients can then choose to receive the intervention or to be part of the “expectant management” arm of the study, where their pregnancy is monitored, an important contribution to the study. 

“Patients in the intervention arm need to transfer their care here and relocate to Houston for treatment at Texas Children’s Fetal Center,” continued Dr. Sanz Cortes. “Their delivery and postnatal care will also be here. After birth, the baby will be cared for by Baylor Medicine pediatric specialists at Texas Children’s Hospital.”  

For those who choose expectant management, the requirements are to return to Texas Children’s Fetal Center at 32 weeks for a fetal ultrasound, MRI, and echocardiogram, and to share the postnatal outcomes of their baby with the study. 

When the RAFT trial first began in 2017, the study included pregnancies with two types of conditions. The first was congenital bilateral renal agenesis (CoBRA), a condition in which there is a complete absence of fetal kidneys. As , that arm of the trial was stopped early based on recommendations from the RAFT Trial Data and Safety Monitoring Board.  

“The arm of the RAFT trial we are joining is for pregnancies where the baby’s kidneys are developing in the beginning of the pregnancy, but suffer injury and stop producing urine,” noted Dr. Sanz Cortes. 

“The decision to join this trial was made together with the multidisciplinary team of specialists who will be involved in the care of these mothers and babies. If we prolong the life of these babies, they’re going to be extremely sick, requiring the care of neonatologists, pediatric nephrologists, transplant medicine doctors, and other team members. We have the extensive team of specialists required, all under one roof, and fetal experts experienced in performing amniofusions.” 

“We believe this is a well-designed and well-regulated study that we need to be part of, enabling us to contribute to an important body of evidence that could help the estimated 1,500 families affected by this condition every year in the U.S. alone,” she continued. “If the science behind this study shows that it is an effective, safe treatment, and we’re able to increase the survival of these babies up to the point that they can have access to dialysis, it could be a huge milestone in the field of fetal surgery.” 

The RAFT trial is funded by the National Institutes of Health (NIH) and sponsored by Johns Hopkins University. The trial is open to eligible patients with a diagnosis of early pregnancy renal anhydramnios (EPRA) before 22 weeks. Patients cannot be enrolled after 26 weeks.  

To refer a patient at Texas Children’s Hospital, contact Dr. Magdalena Sanz Cortes. 

Finding Answers to D-MER Through Neurohormonal Research

As a reproductive psychiatrist, Dr. Megan Howard is passionate about neurohormonal research and the promise it offers for improving the lives of women with reproductive mental health conditions.

“The more we learn about the interactions of hormones in our brains, the greater our understanding of how the hormonal fluctuations associated with pregnancy, childbirth, and lactation can impact our patients’ emotions, cognition, and behaviors,” said Dr. Howard, an assistant professor in the division of Reproductive Psychiatry at �����������.

Dr. Howard’s initial research goal is to better understand patients with dysphoric milk ejection reflex (D-MER).

“Women with this condition experience intense negative emotions as they begin breastfeeding or pumping, when milk is ‘let down’ or released,” she explained. “Feelings like sadness, anxiety, anger, or agitation come on suddenly. They typically last less than five minutes.”

“With its abrupt, predictable onset of symptoms, D-MER offers a unique model for studying how the neurology and the endocrinology of lactation impact mood in real time,” said Dr. Howard. “It also has applications beyond this niche topic, enhancing our understanding of neurocircuitry in general and issues like mood swings – important risk factors for suicide and other impulsive behaviors.”

An estimated 6% to 20% of women suffer from D-MER but the incidence rate could be even higher. There are no formal diagnostic criteria and the cause is unknown.

“One theory is the milk letdown results in a drop in dopamine, a neurotransmitter that helps us feel good, but data is lacking on the patterns of dopamine release in the brain in relationship to lactation – making neuroimaging studies important,” she noted. “Another theory focuses on oxytocin, the hormone responsible for milk ejection. While the timing aligns, we think of oxytocin as the ‘happy hormone’ – not one that causes distress.”

Dr. Howard’s interest in D-MER stems from a series of unusual patient encounters. “The first was a virtual visit. The patient was breastfeeding her baby and appeared deeply depressed – no eye contact, no facial expressions, monotone voice. Then she abruptly finished, looked up and smiled. It was stunning to watch this dramatic shift in her whole affect.”

“Two other patients also reported feeling sad when breastfeeding. Both likened it to a similar feeling following sex, a condition known as postcoital dysphoria that is also not well understood.”

“Women are struggling,” said Dr. Howard. “With little literature on D-MER, there are a lot of questions we can’t answer.”  

Help and support are available at in the form of psychoeducation and behavior modification. “Many women find it helpful just understanding what they’re experiencing, that it’s brief, and it’s not just happening to them. They also learn how to make the breastfeeding environment as calming and comfortable as possible to help offset their symptoms.”

The website is another patient resource, she noted.

“While we work to better understand D-MER, it’s important to be aware of this condition and to understand that breastfeeding, although a wonderful experience for many parents, is not a wonderful experience for everyone,” emphasized Dr. Howard. 

Resources Abound in New Women’s Mental Health Research Program

Dr. Alison Goulding is both a co-director of Baylor’s new Women’s Mental Health Research Program and a beneficiary of the unique support this program offers, helping clinical researchers better understand women’s mental health conditions.

“Mental health disorders are a major cause of maternal morbidity and mortality in this country,” said Dr. Goulding, an assistant professor in the division of Maternal-Fetal Medicine (MFM) at �����������. “I’ve seen the profound impact these disorders can have on pregnancy outcomes, and on women’s health throughout their lifespan. It’s an underappreciated aspect of OB/GYN care that really motivated my research focus.”

As an MFM specialist, she brings a unique perspective to the research program, under the leadership of Dr. Nicole Cirino, director of the division of Reproductive Psychiatry.

“Baylor is home to one of the largest reproductive psychiatry programs in the nation,” noted Dr. Goulding. “We have an opportunity to learn from this patient population, start new trials, contribute to the scientific literature, and also be a resource to help our colleagues think about how mental health affects the areas they work in.”

“Traditionally, big multi-center OB/GYN trials don’t focus on mental health. This is an important aspect of women’s health that needs to be addressed by OB/GYN providers, not just siloed into psychiatry.”

The new program supports collaborative projects from clinical researchers across varied disciplines.

“Here at Baylor, and across the Texas Medical Center (TMC), there are so many opportunities to work with other departments and institutions to advance the field of maternal mental health,” said Dr. Goulding. “We’re working with Baylor’s pediatric cardiology team, for example, to study the mental health of mothers of infants with serious cardiac defects. We’re also collaborating with other leading reproductive psychiatry centers to launch a large multi-site clinical trial focused on preventing postpartum psychosis.”

With support from the Women’s Mental Health Research Program, Dr. Goulding is launching her own independent research career, starting with a study on depression in hospitalized antepartum patients.

“One in three patients who experience antepartum hospitalization will screen positive for depression or anxiety. But to date we haven’t focused on these patients with their unique challenges and opportunities for intervention,” she explained. “Despite evidence that shows they are at a greater risk for mental health disorders, there are no screening, prevention, or treatment guidelines for this high-risk population.”

Today, as she collects preliminary data for her study, she is experiencing firsthand the extensive resources available to help new investigators launch their research programs in the Texas Medical Center.

“In addition to qualitative research, where we’re interviewing patients about their experiences being hospitalized, the is helping us conduct an innovative study on a cohort of patients who experienced antepartum hospitalization at the Pavilion for Women. Using advanced bioinformatics techniques, these data scientists are allowing us to better understand these patients and their needs so that we can develop novel interventions to support their mental health,” said Dr. Goulding.

Her research is funded by a , an NIH-funded grant that the OB/GYN department awards to junior faculty members. “This grant has given me the funds, time, mentorship, and resources that are essential to starting my project and launching my research career,” said Dr. Goulding.

Studying a New Approach to Preventing Anemia In Pregnancy

Maternal-fetal medicine specialist Dr. Sarah Detlefs is teaming up with providers from �����������’s section of Hematology and Oncology on a new study aimed at addressing a gap in today’s prenatal care: the timely detection and treatment of non-anemic iron deficiency (NAID).

“Recent studies found some 40% of pregnant patients in their first trimester had iron deficiency, a major risk factor for the development of anemia,” said Dr. Detlefs, an assistant professor in Baylor's department of Obstetrics and Gynecology. “Yet our current prenatal screening labs often fail to detect it.”

Anemia in pregnancy is associated with an increased risk of preterm delivery, preeclampsia, cesarean delivery, blood transfusion, and a small for gestational age (SGA) baby. “There are also psychosocial aspects of iron deficiency and anemia,” added Dr. Detlefs, “including an increased risk of perinatal and postpartum depression, fatigue, and decreased exercise, altering patients’ quality of life.”

The American College of Obstetricians and Gynecologists (ACOG) recommends anemia screening for all pregnant patients in the first and third trimesters using a Complete Blood Count (CBC). “Unfortunately, those screenings miss a large subset of patients who may have non-anemic iron deficiency, or low iron stores in the body,” noted Dr. Detlefs. “These patients often end up developing anemia as their pregnancy progresses.”

“Our goal is to develop a questionnaire that helps us identify patients in early pregnancy who are most at risk for iron deficiency so we can screen and treat them early, preventing maternal anemia from developing,” she explained.

That screening would include a serum ferritin test to measure long-term iron stores – a simple blood test not currently included in most universal screening panels.

Participants enrolled in the new study must be in their first trimester. Each patient completes a 15-minute online survey, answering questions about their medical history, diet, and symptoms, to evaluate other risk factors for iron deficiency. They also give an extra blood sample during their routine prenatal labs.

“We can then correlate the questionnaire responses with the lab results and develop a brief predictive survey that will be validated in a future study,” said Dr. Detlefs.

The Detection of Non-Anemic Iron Deficiency (NAID) in Early Pregnancy Study is funded by a research award from the . The study is a collaboration with hematologist Dr. Senthil Sukumar, an assistant professor in Baylor’s section of Hematology and Oncology, and their mentor Dr. Jacquelyn Powers, chief of Hematology at Texas Children’s Hospital and associate professor in Baylor’s department of Pediatrics, section of Hematology-Oncology.

“Long-term, our goal is a multidisciplinary hematology clinic, enabling joint visits where we can see and treat these patients together, improving their medical condition and pregnancy outcomes,” said Dr. Detlefs. “This is just the beginning of a really great collaboration.”

Women interested in participating in the NAID study can contact Ellen Tillery at Ellen.tillery@bcm.edu or Alejandra Castillo Cruz at Alejandra.CastilloCruz@bcm.edu.

A Timeless Approach to Advancing Medicine

Dr. Yamely Mendez Martinez was 17 years old when she left her hometown in Mexico to attend medical school. Inspired by the healthcare providers at the hospital where her mother worked, she fulfilled her lifelong dream of becoming a doctor.

“I’ve been fortunate to have many mentors in my life,” said Dr. Mendez Martinez. “After graduation, I came to the Texas Medical Center to do my internship. The doctor I worked under was also a researcher, an area of training I had little exposure to in my medical education up to that point. I learned how to design research studies, , and had an opportunity to travel to conferences and present my research.”

Today she is paying it forward, serving as a mentor in �����������’s SOAR program – Student Opportunities for Advancement in Research. The program provides education and support to Baylor medical students interested in pursuing research.

“It’s a way for me to give back all the help that I’ve received,” said Dr. Mendez Martinez, a senior research coordinator in Baylor’s department of Obstetrics and Gynecology.

“Students can search the to find research projects in their area of interest and connect with research mentors,” she explained. “Travel awards are also available to help them attend conferences and present their research.”

“With research, we can find answers. We learn how things work. And we can develop better clinical solutions. I hope that by sharing my own knowledge I can help other students find their path and become successful researchers, clinicians, or both,” she added.

Dr. Mendez Martinez provides research support for the department of OB/GYN’s placenta accreta spectrum (PAS) program, her primary role, as well as the reproductive endocrinology and infertility (REI) team, consenting and enrolling patients, ensuring regulatory compliance, and providing additional program support as needed.

“I am also a co-investigator of , led by principal investigator Christina Reed, the director of operations for PAS and one of my biggest mentors,” said Dr. Mendez Martinez. “She has been a wonderful light in my life, guiding me and helping me become the person I am today.”

“With her permission, I submitted our music therapy project for the SOAR database and quickly got connected with the student I am now mentoring. She is very interested in this research and how the study was designed, especially since music therapy is currently limited to our pediatric patients at Texas Children’s Hospital. She will be helping me with what may be one of the first literature reviews on music therapy specifically for high-risk pregnancies.”

“As doctors, the Hippocratic Oath makes us all mentors,” noted Dr. Mendez Martinez. “Medical students need to know we as physicians are available to support and guide them, answering their questions as they find their path. Even the smallest piece of advice can have a big impact. When they become doctors, they can continue the cycle. It’s how medical education has worked since the beginning of time. And how we will continue to advance our field.”