Priscilla White (1900 – 1989) was an American physician
White was a pioneer in the management of diabetes during pregnancy and a key figure in the creation of the field of obstetrical diabetes. She implemented the technique of delivering infants of diabetic mothers early, which increased survival rates of the infants.
White is eponymously remembered fro her Classification of Diabetes in Pregnancy first postulated in 1949 and further elaborated in 1965 and 1974. In 1978, White published her final classification of obstetric diabetes in the American Journal of Obstetrics and Gynaecology.
- 1900 – Born March 17 in Boston
- 1917 – Graduated from Quincy High School, Massachusetts
- 1918 – Radcliffe college, Massachusetts where she studied liberal arts
- 1923 – Graduated medicine from Tufts University Medical School in Boston
- 1924 – Started working at the Joslin Clinic with Elliott P. Joslin (1869-1962) and Howard F. Root (1890-1967), where she was tasked with researching juvenile diabetes
- 1932 – With Joslin, founded the Clara Barton Birthplace Camp for Diabetic Girls in Oxford, Massachusetts
- 1934 – Moved to Joslin’s new practice in the New England Deaconess hospital in Boston, Massachusetts
- 1936 – Assisted Hans Christian Hagedorn (1888-1971) in the development of protamine zinc insulin (PZI)
- Assistant professor at Harvard University Medical School and Tufts University Medical school, Boston, Massachusetts
- 1960 – First woman to give the Banting Memorial Lecture and receive the Banting Medal, The American Diabetes Association’s highest award
- 1975 – Retired
- 1978 – Published her classification of obstetric diabetes in the American Journal of Obstetrics and Gynaecology
- 1989 – Died from a heart attack, December 16 in Ashland, Massachusetts
White Classification of Diabetes in Pregnancy (1949)
A classification of diabetes in pregnancy based on age at onset, duration, presence of atherosclerotic vascular disease and renal complications. This classification system is widely used to to assess maternal and foetal risk based on maternal risk factors.
According to White’s classification of Diabetes in Pregnancy (1949), there were 2 classes of gestational diabetes:
- Class A1: gestational diabetes; diet controlled
- Class A2: gestational diabetes; medication controlled
- Class B: onset at age 20 or older or with duration of less than 10 years
- Class C: onset at age 10-19 or duration of 10–19 years
- Class D: onset before age 10 or duration greater than 20 years
- Class E: overt diabetes mellitus with calcified pelvic vessels
- Class F: diabetic nephropathy
- Class H: ischaemic heart disease
- Class R: proliferative retinopathy
- Class RF: retinopathy and nephropathy
- Class T: prior kidney transplant (added by Tagatz et al 1975)
History of pregnancy in diabetic patients
With insulin treatment (available in 1922), diabetic girls had begun to grow at normal rates, to mature and soon presented us with the problems of their pregnancies characterized by a high risk of fetal loss. Little was known about pregnancy and diabetes prior to the availability of insulin. Bouchardat, the most famous French clinician of the nineteenth century, had never treated, had never even seen a pregnant diabetic woman.White, 1978
In his extensive experience of 19 years (1898-1917), Joslin, treated 1,300 patients with diabetes. In this group, the distribution by sex was equal. Only 10 pregnancies were observed in women with overt diabetes: four live-born surviving infants, two intrauterine foetal deaths, and three maternal deaths. Two of these women died undelivered and one committed suicide after both of her pregnancies were terminated.
White responded to the desire of her female patients to have successful pregnancies by introducing strict management of the pregnant woman’s diabetes, intensive foetal monitoring, and early delivery to avoid late-term complications. Her approach dramatically decreased maternal deaths and fetal losses at the Joslin Clinic during the 1930s and 1940s. Under White’s direction, maternal deaths dropped by over 90% and foetal survival rose to 97%
[Women] refused to acquiesce to the medical advice that they avoid pregnancy or that they end their pregnancies. These women dismissed the course of treatment prescribed by physicians who opposed diabetic pregnancy and instead sought out doctors who would support their desire to have children. Their rejection of that medical advice forced the creation of the specialty field of obstetrical diabetes.Foy 2013: 70
- Joslin EP, Root HF, White P. The Growth, Development and Prognosis of Diabetic Children. JAMA. 1925;85(6):420-422.
- White P. Diabetes in childhood and adolescence. 1932
- White P. Recent Progress in Severe Diabetes. Canadian Medical Association Journal, 1935; 35(2): 153-161
- White P. Pregnancy complicating diabetes. Am J Med. 1949 Nov;7(5):609-16.
- White P. Childhood diabetes. Its course, and influence on the second and third generations. Diabetes. The Banting Memorial Lecture, 1960 Sep-Oct;9:345-55
- White P. Pregnancy and diabetes, medical aspects, Med. Clin. North Am. 1965; 49: 1015-1024.
- White P. Life cycle of diabetes in youth. 50th anniversary of the discovery of insulin (1921-1971). J Am Med Womens Assoc (1972). 1972; 27(6): 293-303
- White P. Diabetes mellitus in pregnancy. Clin Perinatol. 1974; 1(2): 331-347.
- White P. Classification of obstetric diabetes. Am J Obstet Gynecol. 1978 Jan 15;130(2):228-30.
- Dunn PM. Dr Priscilla White (1900-1989) of Boston and pregnancy diabetes. Arch Dis Child Fetal Neonatal Ed. 2004 May;89(3):F276-8.
- Baskett TF. White, Priscilla (1900–1989). Eponyms and Names in Obstetrics and Gynaecology. 3e. 2019: 448-449
- Castagnetti B. Priscilla White (1900–1989). Embryo Project Encyclopedia. 2018
- Farley A. Against Medical Advice: Priscilla White and Diabetic Pregnancy. Lady Science. 2019
- Papers of Priscilla White, 1913-1989. Schlesinger Library, Radcliffe Institute
- Bibliography. White, Priscilla. WorldCat Identities
- Bouchardat A. De la glycosurie, ou, Diabète sucré: son traitement hygiénique. 1875
- Peel J. A historical review of diabetes and pregnancy. J Obstet Gynaecol Br Commonw. 1972 May;79(5):385-95.
- Tagatz GE, Arnold NI, Goetz FC, Najarian JS, Simmons RL. Pregnancy in a juvenile diabetic after renal transplantation (class T diabetes mellitus). Diabetes. 1975; 24(5): 497-501.
- Feudtner C, Gabbe SG. Diabetes and pregnancy: four motifs of modern medical history. Clin Obstet Gynecol. 2000 Mar;43(1):4-16
- Foy ME. “Our Objective Wasn’t to Belittle People’s Behavior”: The History of Gestational Diabetes, 1921-1991. 2013: 67-116
the person behind the name