Featured Researcher — Sarah O’Brien, MDFeatured Researcher — Sarah O’Brien, MD https://pediatricsnationwide.org/wp-content/themes/corpus/images/empty/thumbnail.jpg 150 150 Katie Brind'Amour, PhD, MS, CHES Katie Brind'Amour, PhD, MS, CHES https://pediatricsnationwide.org/wp-content/uploads/2021/03/Katie-B-portrait.gif
- September 14, 2022
- Katie Brind'Amour, PhD, MS, CHES
The lab of Sarah O’Brien, MD, principal investigator in the Center for Child Health Equity and Outcomes Research at Nationwide Children’s Hospital, operates at the intersection of hematology and women’s health. Dr. O’Brien, who also leads the Young Women’s Hematology Clinic at Nationwide Children’s, applies her interests in big data and epidemiology to increase recognition and understanding of everything from heavy menstruation and hormonal contraceptive safety to iron deficiency anemia and reproductive health in women with sickle cell disease.
In all of her efforts, Dr. O’Brien strives to enroll a diverse population. The bulk of medical data on menstruation came from studies conducted in the 1970s in Scandinavia, so broadening the range of races, ethnicities and body types represented is an essential part of advancing this field of research and improving the quality of care offered to hematology patients.
Dr. O’Brien and her team are making significant progress examining Medicaid data to study contraceptive safety and pregnancy outcomes among women with sickle cell disease, funded by the National Institutes of Health (NIH). Her research team is also continuing to pilot a mobile app it developed, called T-DOT (Teen-Period). The NIH-funded project is expected to wrap up this year and has 150 girls (ages 10-14) tracking their menstrual cycles for 6 months, reporting flow as well as period-related physical symptoms and impacts on quality of life. If the pilot study finds good engagement and valuable data, the team will roll it out on a much larger scale to accumulate valuable insight regarding what is truly normal and abnormal during the early years of menstruation. In time, Dr. O’Brien hopes the effort will help them identify abnormal menses and reproductive concerns earlier in life so young women can get the right care sooner.
Read on to learn more about Dr. O’Brien and her work.
What was your path to your current role?
I’ve always known I wanted research to be a big part of my career. In medical school, I spent a summer working with a pediatrician on her study to determine whether using a numbing spray on babies before they received immunizations would make them cry less. It went nowhere, because the babies got upset before their shots when they felt the cold spray. I have no publication to show for that hard work, but I loved the whole process of figuring out a question and how to answer it and writing up the project. My research mentor was a mother of young children at that time in her career, and seeing how she successfully wove together her passion for science and her love for her family also made a big impression on me.
When I started my fellowship in hematology and oncology, I went into it — like many people — based on the amazing experience I had taking care of cancer patients in the hospital. As I advanced in my training, I became intrigued by how little we know about hemostasis and thrombosis and decided to specialize in hematologic diseases. My first grant as a fellow was a small pharmacokinetics study of a new dosing pattern for anticoagulation in children, and then I moved into clinical trial work for new treatments for blood clots.
I started at Nationwide Children’s 16 years ago. About a year after I arrived, one of our hematology nurses approached me after attending a meeting where she had heard about a combined clinic between hematology and gynecology at another institution. Looking back at our cases, about one-third of our patients with heavy menstrual bleeding seen by hematology were then referred to adolescent medicine or gynecology. It was the same for them referring to us when they saw a new patient with heavy menses. It was easy to make the case for a combined clinic here, and in 2008 we officially started the Young Women’s Hematology Clinic.
I fell in love with working with this niche patient population, and I really started to recognize its unmet needs. That’s when I pivoted to focus my research efforts on young women’s hematology as well. On my first call with a program officer at the NIH, I was advised not to get involved with menstrual bleeding. The woman on the phone told me it was considered a nuisance by study sections, not a medical issue. She was trying to give good professional advice, but it just further drove my passion and desire to advance the field. Ten years on, it’s very different in young women’s hematology, and the need for research in women’s health is much better recognized. I’m very glad I stayed my course.
Why did you decide to come to Nationwide Children’s?
At the time I was recruited, Nationwide Children’s was beginning to make the shift from community-based hospital to one with a national reputation and a major research institution. It felt exciting to be part of that growth and to see everyone’s enthusiasm.
The people who recruited me, Bryce Kerlin, MD, principal investigator in the Center for Clinical and Translational Research, and Kelly Kelleher, MD, principal investigator in the Center for Child Health Equity and Outcomes Research, had such a passion for what they were doing, and that was inspiring. They, just like my current leadership, including Deena Chisolm, PhD, director of the Center for Child Health Equity and Outcomes Research, understand it’s hard to both see patients and be heavily invested in research, and they were willing to give me the resources and protected time to make that happen.
Fun Facts About Dr. O’Brien
What’s your favorite word, and why?
My kids would say it’s “awesome.” Apparently I use it all the time.
What do you usually eat for breakfast?
I always have a Nutri-Grain bar, paired with an enormous Big Gulp fountain soda.
What’s your dream job (besides working in research)?
I was a cellist throughout school. My dream job would be playing as a cellist for Broadway shows. I always loved playing for the musicals in high school, sitting in the orchestra pit.
What’s your favorite food?
I don’t have a favorite, but I checked off two artists on my bucket list last year when I saw James Taylor and Elton John in concert.
Favorite thing you’ve bought this year?
I hired a post-COVID wardrobe consultant and totally freshened up my wardrobe this spring. It was fun — a humbling but very enjoyable experience.
The hospital also has much stronger nursing support in hematology than many other children’s hospitals, which makes a huge difference in enabling me to do research. I’ve been fortunate to work with several of our nurses for the whole 16 years I’ve been here, which is amazing.
What’s your favorite part of your job?
My dad was a sports journalist, and I would say my job is more similar to being a newspaper reporter than many would guess. My favorite part about research is writing up my findings and reviewing papers for publication. I’m a bit of an editor at heart, and I served as a yearbook editor in high school, college and even medical school. If I have two hours with no meetings and I get to edit a paper, that’s a happy day for me.
I also enjoy the detective work of meeting a new patient with a bleeding problem and figuring out what is causing it. I love it so much I requested to be able to spend a greater portion of my clinic time with new patients. I’m a huge fan of mystery novels and TV shows, and with new clinic cases, I can solve real-life mysteries.
How does your research serve our patients and our community?
A lot of my patients tell us just knowing the Young Women’s Hematology Clinic exists switches on a lightbulb for them. Suddenly, they realize they are not the only one struggling with heavy menses — there is a whole clinic full of girls coping with the same thing. It gives patients confidence knowing what they’re experiencing is a medical issue we can help take care of. I love getting patients back to school without absences and back to sports without anxiety about accidents.
I remember coming home from the hospital with each of my four kids, three of whom are girls. They give you a chart to mark down all the feedings and diapers, and tell you to call if you don’t have X number of wet and dirty diapers per day for the first week. Fast-forward 12 years, and moms have no idea what daughters are supposed to be experiencing when they start menstruating. There is no guidebook handed out. Our mobile app project should help everyone by making it clear what is normal and what isn’t, so parents, family doctors, pediatricians and specialists are aware. We all need to be comfortable talking about menstrual periods. If we aren’t, we won’t learn if someone is having a problem. As a mentor, my main goal is teaching trainees to be really comfortable asking questions about menstruation, because patients may not feel comfortable bringing it up.
As a hematologist, all my research in this area to date has been on young women who someone else thought to refer to hematology. With my upcoming grant, we’re taking the research to a primary care setting. That is where girls are presenting for health supervision visits. My long-term goal is to do research that helps us define quick tools primary care offices can use to identify girls struggling with heavy menstrual bleeding. The grant will look at brief bleeding questionnaires and a point-of-care iron test to signal whether bleeding may be too heavy. We also hope to find a way to balance the identification of young women with bleeding disorders with something feasible to incorporate into a busy practice.
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