Throughout the month of August, we will be sharing important milestones from Joslin’s rich history. More than a century after its creation, Joslin continues its legacy as an internationally recognized diabetes treatment and research institution. This month we are celebrating the talented and dedicated individuals who have contributed to and continue to focus on our mission of preventing, treating and curing diabetes.
Priscilla White, M.D., had a unique destiny. “Dr. Joslin hired her in an era when women were even having trouble getting into medical school,” says Donald Barnett, M.D., a retired Joslin diabetologist and historian. “Thanks to her perseverance, today women with diabetes are able to achieve successful pregnancies at a rate nearly matching mothers without diabetes.”
Over Dr. White’s long career, which began at Joslin in 1924, the fetal success rate rose from 54 percent to more than 90 percent, approaching where it stands today—approximately 95 percent. With extraordinary devotion to her patients, she was with them during childbirth. When she retired, the hallways of Joslin were flooded with thankful mothers and offspring celebrating her professional expertise and courage, which had resulted in life itself.
Nearly singlehandedly, Dr. White fought the prevailing opinion that women with diabetes should avoid pregnancy. Instead, she championed Dr. Joslin’s stance that tight control of diabetes was the best way to stave off complications. She added another dimension, based on adjusting medications and diet to align with hormonal changes that occur during pregnancy. The White Classification of Diabetic Pregnancies is still used today. Refined over the years, it categorizes patients according to their risk as determined by age of diabetes onset, duration, and presence of heart, kidney and eye complications.
Today, the Pregnancy Program at Joslin continues to thrive under the direction of Florence Brown, M.D. Each year, the program attracts more than 200 mothers-to-be from around New England. Patients have type 1 or 2 diabetes or gestational diabetes. Their diabetes is monitored closely in concert with their obstetric team.
In pregnancy, the placenta makes hormones that increase the body’s resistance to insulin, causing the mother’s blood glucose to rise. This can cause preeclampsia, a potentially life threatening condition characterized by high blood pressure and excessive protein in the urine. High blood glucose levels around the time of conception increase the risk of birth defects in the baby. Moreover, excess glucose from the mother may cross the placenta and be stored as fat, causing a high-birth-weight infant with increased risk for obesity and diabetes later in life. The strategy is to keep blood glucose as close to normal as possible during the nine-month gestation period.
Lab research at Joslin also is underway. Mary Loeken, Ph.D., has discovered crucial clues about the causes of birth defects that may occur in pregnancies of women with diabetes. And Mary-Elizabeth Patti, M.D., is exploring how the risk of developing type 2 diabetes can be handed down to the following generations in ways not based on parental DNA, but possibly on factors such as poor nutrition or reduced muscle mass.