Priscilla White

Priscilla White (1900 - 1989)

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.


Biography
  • 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

Medical Eponyms
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

In 1965, White added a further group of patients with proliferative retinopathy (Class R), and updated in 1974 to the table most used today. There are 9 classes of pre-gestational diabetes:

  • 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%

White Pregnancy and diabetes (2,307 viable pregnancies, 1898 to 1977, Joslin Clinic) 1978
Pregnancy and diabetes: 2,307 viable pregnancies (1898-1977) at the Joslin Clinic) White, 1978

[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

There is hardly a subject of more importance in the study of diabetes than its prediction, except its prevention or its cure

White, 1978

Major Publications

References

Biography

Eponymous terms


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Graduated from Cardiff Medical School in 2017 with MBBCh and BSc in Psychology and Medicine. Currently working as a doctor in the emergency department at Sir Charles Gairdner Hospital in Perth, Australia.

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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