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PubMed2001

Fecal leukocyte stain has diagnostic value for outpatients but not inpatients.

The methylene blue stain for fecal leukocytes (FL) is widely used as an adjunct to slower but more accurate tests of diarrheal etiology, such as stool culture (SCx) or toxin assays for Clostridium difficile. Prior studies investigating the utility of FL for predicting SCx and C. difficile toxin assay (CDTA) results did not evaluate the importance of inpatient versus outpatient status. We conducted a study of patients who submitted a stool specimen to the Stanford Hospital Microbiology Laboratory between May 1998 and April 1999. The results for stool specimens that were tested by FL and by a confirmatory test (either SCx or CDTA) were used to determine whether the FL method helped to predict the results of these tests. Of 797 stools that were tested by FL method and at least one confirmatory test, 502 stools were tested by CDTA, and 473 stools were cultured. The FL test was 14% sensitive and 90% specific for C. difficile with a diagnostic threshold of one white blood cell/high-power field (WBC/HPF). The overall likelihood ratio (LR) for a positive CDTA was 1.4 with a 95% confidence interval (CI) of 0. 5 to 3.7 (P = 0.5) and was similar among inpatients and outpatients. In contrast, the presence of >/=1 WBC/HPF was 52% sensitive and 88% specific for the 27 positive SCx results and helped to predict a positive SCx result (LR, 4.2; 95% CI, 2.7 to 6.5; P < 0.001). The sensitivity of >/=1 WBC/HPF was 57%, and its predictive value for SCx was higher among outpatients (outpatient LR, 5.0; 95% CI, 2.9 to 8.6; P < 0.001; inpatient LR, 1.9; 95% CI, 0.3 to 10.8; P = 0.5). Among inpatients, only 4 (1.5%) of the 273 SCx results were positive, and the presence of >/=1 WBC/HPF was insensitive (25%) and did not predict a positive SCx (LR, 1.9; 95% CI, 0.3 to 10.8; P = 0.5). When the data were reanalyzed using a diagnostic threshold of five WBC/HPF for FL, the predictive power of the FL method was similar. Thus, FL was of no value in predicting CDTA positivity, nor was it helpful in predicting SCx results for inpatients. Neither SCx nor the FL method should routinely be performed on samples from inpatients. Among outpatients, presence of FLs should suggest a bacterial diarrhea in clinically compatible cases.

Bacterial Proteins↗
PubMed2006

Relationship between perioperative troponin elevation and other indicators of myocardial injury in vascular surgery patients.

BACKGROUND: In 2000 the European Society of Cardiology and the American College of Cardiology published a consensus document revising the definition of myocardial infarction. The usefulness of this revised definition has been challenged. It has been suggested that, rather than any release of cardiac troponin being potentially diagnostic of myocardial infarction, a diagnostic threshold consistent with significant myocardial injury should be defined. METHODS: We studied 65 patients undergoing elective major vascular surgery to examine the relationship between the magnitude of cardiac troponin I (cTnI) and creatine kinase MB fraction (CK-MB) release and clinical signs or symptoms of myocardial injury. cTnI and CK-MB concentrations were measured preoperatively and on the first 4 postoperative days using the ACCESS assay (Beckmann). Patients were considered to have suffered a perioperative myocardial infarction if they had either symptoms or ECG changes consistent with this diagnosis, together with cTnI release. RESULTS: Peak postoperative cTnI concentrations above the lower detection limit of the ACCESS assay (0.06 microg litre(-1)) occurred in 26 patients. Eight of these patients displayed symptoms or ECG changes consistent with myocardial injury. A cTnI level greater than 0.68 microg litre(-1) was found to be consistent with the clinical diagnosis of myocardial infarction. The optimal cut-off for the diagnosis of MI using CK-MB was 40.4 microg litre(-1). CONCLUSIONS: These data suggest that further studies are required to define the optimal cardiac troponin diagnostic threshold for the diagnosis of myocardial infarction in the non-cardiac surgery population.

Aged↗
PubMed2000

Caries-associated micro-organisms in infants from different socio-economic backgrounds in Scotland.

OBJECTIVES: The aims of this study were: (1) to compare the frequency of isolation of mutans streptococci, (Streptococcus mutans, Steptococcus sobrinus), lactobacilli and yeasts (caries-associated micro-organisms) in the saliva of 1-year-old infants with and without dental caries; and (2) to determine if socio-economic background influenced the frequency isolation of bacteria and caries status. METHODS: 1393 1-year-old consented infants, who comprised 70. 3% of children born in Dundee during a 1year period, had saliva samples taken (tongue-loop method) for microbiological culture and were examined for dental caries (d(1)-threshold: enamel and dentine diagnostic threshold). Thirty-nine infants were diagnosed with caries and the frequencies of isolation of caries-associated micro-organisms (and absolute microbial counts) were compared with infants who were caries-free. In addition, associations were sought between the infants' socio-economic background, the frequency of isolation of caries-associated micro-organisms and caries status. RESULTS: Streptococcus mutans, lactobacilli and yeasts were isolated more frequently from those infants with caries compared to those who were caries-free (S. mutans: 29.7 vs 9.8%, P=0.0008; lactobacilli: 15.4 vs 4.3%, P=0.0073; yeasts: 23.7 vs 10.4%, P=0.0016-Fisher's exact test). There were no significant differences between the isolation frequencies of S. sobrinus (2.7 vs 1.3%, P=0.39) from those with and without caries. Significantly, more infants living in areas of high deprivation had caries compared to those from more affluent areas (DEPCAT 6 and 7 vs 1-5: 3.6 vs 1.9%, P=0.049), but, apart from yeasts, socio-economic background was not significantly associated with the isolation frequencies of any of the caries-associated micro-organisms. CONCLUSIONS: In infants as young as 1year of age, salivary S. mutans, lactobacilli and yeasts but not S. sobrinus were isolated significantly more frequently from those with caries compared to those who were caries-free. Apart from yeasts, socio-economic background did not influence the frequency of isolation of caries-associated micro-organisms. However, infants living in areas of highest deprivation had significantly higher frequencies of caries compared to those from more affluent areas.

Colony Count, Microbial↗
PubMed1989

A computer program to determine diagnostic decision thresholds and likelihood ratios illustrated with aspartate aminotransferase activities after a myocardial infarction.

We describe an enhancement of our earlier computer program which allows calculation of decision thresholds, sensitivity and specificity, and likelihood ratios of negative and positive test results for any chosen value of sensitivity or specificity. The program will also plot continuous receiver operating characteristic and decision level curves which permit examination of the contours created by using all the available data. We illustrate the value of these routines by showing that the sensitivity and specificity of serum aspartate aminotransferase changes during the course of a myocardial infarction.

Aspartate Aminotransferases↗
PubMed2003

Optimal threshold for diagnosis of ventilator-associated pneumonia using bronchoalveolar lavage.

UNLABELLED: BACKGROUND Identification of ventilator-associated pneumonia (VAP) with invasive methods such as bronchoalveolar lavage (BAL) paired with treatment is associated with improved mortality. Inappropriate antibiotic use, however, is known to increase bacterial resistance, making future treatment problematic. Thus, the diagnostic threshold for VAP in BAL must yield adequate sensitivity while limiting exposure of patients to unnecessary antibiotics. Our institution uses a cutoff of > or = 10(5) colony-forming units (CFUs)/mL, but the optimal cutoff remains an area of debate. In this project, the effects of lower diagnostic cutoffs on VAP diagnosis and unnecessary antibiotic use are examined. METHODS: Records of all patients admitted to the trauma intensive care unit over a 2-year period requiring > 48 hours of mechanical ventilation were reviewed. Number of BALs, quantity of organism on each BAL, and presence of VAP (> or = 10(5) CFUs/mL) were noted. Indication for BAL was pulmonary infiltrate, sepsis syndrome, and C-reactive protein > 17 microg/dL at > or = 48 hours after admission. RESULTS: From January 1, 2000, to December 31, 2001, 563 patients were admitted to the trauma intensive care unit. Two hundred fifty-seven required > 48 hours of mechanical ventilation, and 257 BALs were performed in 168 (65%) of these patients. One hundred thirty-nine episodes of VAP occurred in 109 (42%) patients. Subdiagnostic quantities of bacteria (> or = 10(2) but < 10(5) CFUs/mL) were seen in 98 BALs. Of these, only 16 (16%) episodes of VAP with the same organism were seen later during hospitalization. At a threshold of > or = 10(4) CFUs/mL, 4 of 28 (14%) patients went on to develop pneumonia. A similar pattern was seen at diagnostic thresholds of > or = 10(3) CFUs/mL (10 of 72 [14%]) and > or = 10(2) CFUs/mL (16 of 98 [16%]). CONCLUSION: A threshold of > or = 10(5) CFUs/mL for VAP diagnosis carries a low false-negative rate. Over 80% of additional patients who would have been treated had a threshold of > or = 10(4) CFUs/mL been used recovered without treatment and thus would have undergone unnecessary antibiotic exposure. A similar pattern is seen at all lower thresholds. Lower diagnostic thresholds would lead to marginal increase in sensitivity, and many would receive unnecessary VAP treatment with potential for increasing bacterial resistance.

Adult↗
PubMed1999

Dependence symptoms but no diagnosis: diagnostic 'orphans' in a 1992 national sample.

The alcohol dependence syndrome was initially presented as a condition with graded severity. However, to receive a diagnosis that is categorical, a diagnostic threshold must be determined. Much previous research on this issue has focused on setting a threshold that will produce the highest possible consistency in rates between one set of diagnostic criteria and the next. It is possible that a different threshold may be more valid. Results from a community sample supported a minimum diagnostic threshold of three or more dependence symptoms but the sample was not nationally representative. Therefore, we investigated the meaning of the 'orphan' status (one or two dependence symptoms but no DSM-IV alcohol dependence diagnosis) in a large national sample. Two sets of analyses were performed, the first using a current timeframe and the second using a lifetime timeframe. Abstainers were excluded from all analyses. In each set of analyses, three groups were compared: subjects with no symptoms of any alcohol use disorder; diagnostic 'orphans' with one or two symptoms of dependence; and subjects who met full criteria for DSM-IV alcohol dependence. Several variables significantly differentiated the three groups, including heavy drinking and family history of alcoholism. Group differences were reduced among 'orphans' and subjects with no symptoms who had at least one occasion of drinking five or more drinks in the year prior to the interview. The results provide support for the decision to require a minimum of three symptoms to make a diagnosis of alcohol dependence, for scientific as well as pragmatic reasons.

Adolescent↗
PubMed2006

Multimarker panel to rule out acute coronary syndromes in low-risk patients.

OBJECTIVES: To test novel markers of acute coronary syndrome (ACS), monocyte chemoattractant protein-1 (MCP), myeloperoxidase (MPO), C-reactive protein (CRP), and brain natriuretic peptide (BNP) in low-risk emergency department (ED) patients who were evaluated for ACS in a chest pain unit (CPU). METHODS: A convenience sample of 414 patients underwent CPU evaluation, including provocative testing, and were followed prospectively for 45 days for ACS, which was defined as death, myocardial infarction (MI), revascularization, or >60% coronary artery stenosis prompting new medical treatment, adjudicated by three blinded reviewers. Published diagnostic thresholds were used to calculate diagnostic indices for each marker and for the multimarker panel. RESULTS: The prevalence of ACS was 7 in 414 (1.7%; 95% CI = 0.7% to 3.5%). Only MCP demonstrated a negative likelihood ratio [LR(-)] of less than 0.5, with a sensitivity of 85% (95% CI = 42% to 99%), specificity of 72% (95% CI = 67% to 76%), and LR(-) of 0.20 (95% CI = 0.04 to 0.71). For MPO, CRP, and BNP, LR(-) was 0.89 (95% CI = 0.26 to 2.05), 0.79 (95% CI = 0.40 to 1.01), and 0.90 (95% CI = 0.51 to 1.03), respectively. The sensitivity, specificity, and LR(-) of an abnormal multimarker panel were 86% (95% CI = 42% to 100%), 17% (95% CI = 13% to 21%), and 0.84 (95% CI = 0.15 to 3.12), respectively. CONCLUSIONS: The prevalence of ACS was very low but was similar to reports from other CPUs. BNP and CRP had high specificities, but had limited sensitivities, whereas MPO had a low specificity. Only MCP had a low LR(-) and should be studied further. The combined multimarker panel had an unexpectedly low sensitivity and specificity, yielding an LR(-) of 0.84, suggesting that the panel would not be an efficient screening test to decrease unnecessary CPU testing.

Acute Disease↗
PubMed2003

Longitudinal trajectories of depression and anxiety in a prospective community study: the Zurich Cohort Study.

BACKGROUND: The dearth of long-term follow-up studies of community-based samples and differences in methodology in existing studies highlight the need for research designed to examine the stability, comorbidity, and diagnostic thresholds of depression and anxiety in the community. METHODS: Prospective study of a community-based cohort aged 19 and 20 years from the canton of Zurich, Switzerland. Semistructured diagnostic interviews were administered by clinically experienced interviewers at 5 assessment points during a 15-year period. The format of the interview permitted assessment of major mental disorders at both the diagnostic and subthreshold levels. RESULTS: Comorbid anxiety and depression tended to be far more persistent than either syndrome alone. Individuals with anxiety states alone tended to develop either depression alone or comorbid anxiety and depression as they progressed through adulthood. In contrast, depression alone and depression comorbid with anxiety tended to be more stable than anxiety alone over time. The patterns of stability were similar for subthreshold- and threshold-level disorders. CONCLUSIONS: These findings have important implications for classification and treatment of affective disorders. The greater stability of comorbid anxiety and depression than either disorder alone illustrates the importance of further investigation of comorbid states compared with noncomorbid states in etiologic and treatment research. The persistence of subthreshold-level depression and anxiety from early to mid adulthood also suggests the importance of characterizing the continuum of expression of depression and anxiety rather than adhering to strict diagnostic thresholds.

Adult↗
PubMed1987

[Sequential diagnostic procedure in the evaluation of the tumoritropic properties of radiopharmaceuticals].

The optimum value of diagnostic procedure in the assessment of RP tumoritrophism (99mTc-pyrophosphate) was shown. The results of radionuclide studies using 99mTc-pyrophosphate in 193 patients with bone pathology were cited by way of example. Diagnostic thresholds with error levels were established. The diagnostic criteria (sensitivity, specificity, accuracy, etc.) were established proceeding from the criteria of malignant and benign features. Some differential-diagnostic potentialities of 99mTc-pyrophosphate in the recognition of certain groups of bone pathology were revealed.

Bone Diseases↗
PubMed1983

Theoretical and experimental studies of the influence of air kerma rate on threshold contrast in diagnostic fluoroscopy systems.

Experimental measurements of threshold contrast (CT) as a function of air kerma rate at the input plane of the image intensifier have been made for several diagnostic fluoroscopy units in clinical use. Threshold contrasts are determined by viewing a test object containing holes of fixed diameter and various depths under defined irradiation conditions. Kerma rate variations are effected by introducing aluminum sheets into the x-ray beam at fixed values of tube potential and current. At low kerma rates where quantum noise dominates, low tube potentials (60 kVp) usually yield lower values of CT than do higher potentials (100 kVp). At higher kerma rates the opposite is often true. A simple theoretical model for noise propagation in fluoroscopic imaging systems using models of diagnostic x-ray spectra lends qualitative support to the experimental findings. The often-quoted suggested upper limit of 100 mu R s-1 (0.87 mu Gy s-1) at the input phosphor would seem to be justified under the test conditions since little improvement in CT is usually observed at higher kerma rates. However, application to clinical practice would ideally require the use of more realistic phantom studies.

Air↗
PubMed2005

A simplified technique for scoring DSM-IV personality disorders with the Five-Factor Model.

The current study compares the use of two alternative methodologies for using the Five-Factor Model (FFM) to assess personality disorders (PDs). Across two clinical samples, a technique using the simple sum of selected FFM facets is compared with a previously used prototype matching technique. The results demonstrate that the more easily calculated counts perform as well as the similarity scores that are generated by the prototype matching technique. Optimal diagnostic thresholds for the FFM PD counts are computed for identifying patients who meet diagnostic criteria for a specific PD. These threshold scores demonstrate good sensitivity in receiver operating characteristics analyses, suggesting their usefulness for screening purposes. Given the ease of this scoring procedure, the FFM count technique has obvious clinical utility.

Adolescent↗
PubMed1996

Further studies of brain cholinesterase: cholinergic receptor ratios in the diagnosis of acute lethal poisoning of birds by anticholinesterase pesticides.

Cholinesterase (ChE) and the muscarinic (mAChR) and nicotinic (nAChR) cholinergic receptors were measured in the brains of 86 birds of 20 different species collected in Saskatchewan, Canada during 1991 and 1992. There was a strong correlation between ChE and mAChR, and the ratio of ChE: mAChR was 38% less variable than was ChE alone. In a hypothetical test for minimal acute lethal poisoning of all birds based on a reduction by 50% of the normal ChE measured in each, the use of a single diagnostic threshold value of the ChE: mAChR ratio had a diagnostic sensitivity of 98% and a specificity of 99%, thus making theoretically possible the diagnosis of acute lethal poisoning by anticholinesterase chemicals without the use of reference control values for ChE. Both ChE and mAChR were highly stable during 12 days of postmortem decomposition under several different daily temperature regimes. Substantial changes in these molecules occurred only under conditions of constant high temperature (36 C). Acute lethal poisoning by the organophosphate chlorpyrifos did not affect the density of mAChR. Postmortem decomposition did not appear to be an important confounding factor in the diagnostic interpretation of either ChE or the ChE: mAChR ratio except under hot climatic conditions.

Analysis of Variance↗
PubMedDate not supplied

Comparing Personality Diagnostic questionnaire-4+ with Longitudinal, Expert, All Data (LEAD) standard diagnoses in a sample with a high prevalence of axis I and axis II disorders.

A comparison between the Personality Diagnostic Questionnaire-4+ (PDQ-4+) and Longitudinal, Expert, All Data (LEAD) standard diagnoses was made in a sample of 100 patients with a high prevalence of both axis I and axis II disorders. The internal consistency was considered acceptable (alpha >.70) for 3 of 12 PDQ-4+ scales. Diagnostic agreement between the assessment methods was poor for specific personality disorders (PDs). The PDQ-4+ gave many false-positive diagnoses. Changing the diagnostic thresholds only marginally increased the agreement between methods or the diagnostic efficiency of the PDQ-4+. Multiple regression analyses showed that the discrepancies between the methods were strongly associated with the current level of perceived symptoms (SCL-90-R).

Adult↗
PubMed1995

Thresholds for auditory brain stem responses to tones in notched noise from infants and young children with normal hearing or sensorineural hearing loss.

OBJECTIVE: To assess the accuracy of threshold estimates determined using the auditory brain stem responses (ABRs) to brief tones presented in notched noise in a group of infants and young children with normal hearing or sensorineural hearing loss (SNHL). DESIGN: The thresholds for ABRs to brief duration 500, 2000, and 4000 Hz tones presented in notched-noise masking were evaluated in infants and young children with normal hearing (N = 34) or SNHL (N = 54). Tone-evoked ABR thresholds were compared with behavioral thresholds obtained at follow-up audiologic assessments, for a total of 220 comparisons. RESULTS: ABR thresholds for the infants with bilateral normal hearing were 23.6, 12.9, and 12.6 dB nHL for 500, 2000 and 4000 Hz, respectively. Most (92 to 100%) infants with normal hearing showed ABRs to 30 dB nHL tones. Across all subjects (i.e., those with normal hearing and those with impaired hearing), high ( > or = 0.94) correlations were found between the ABR and behavioral thresholds. The mean differences between ABR (dB nHL) and behavioral (dB HL) thresholds across all subjects were 8.6, -0.4, and -4.3 dB for 500, 2000, and 4000 Hz, respectively. Overall, 98% of the ABR thresholds were within 30 dB of the behavioral thresholds, 93% were within 20 dB, and 80% were within 15 dB. CONCLUSIONS: These threshold results for the ABR to brief tones in notched noise obtained for infants and young children are similar to those obtained in similar studies of adults. The technique may be used clinically with reasonable accuracy to estimate pure-tone behavioral thresholds in infants and young children who are referred for diagnostic threshold ABR testing.

Audiometry, Pure-Tone↗
PubMed1997

Diagnostic agreement between the DSM-IV and ICD-10-DCR personality disorders.

The SCID-II Personality Questionnaire, modified for DSM-IV and ICD-10 Diagnostic Criteria for Research (ICD-10-DCR), was administered to 58 consecutive patients with agoraphobia with panic disorder in order to screen for personality disorders (PDs) and assess diagnostic agreement between DSM-IV and ICD-10-DCR. The diagnostic agreement, as expressed by kappa values, was 0.78 for the presence of any personality disorder (PD), but it ranged from 0.51 for schizoid PD to 0.83 for dependent PD. There was a tendency for ICD-10-DCR to overdiagnose PDs, except for borderline and dependent PDs. The sources of disagreement can be traced to differences in the conceptualization of some PDs and differences in diagnostic criteria and diagnostic thresholds; these are further examined in an effort to improve diagnostic criteria and attain greater compatibility between the two diagnostic systems.

Adult↗
PubMed2001

Clinical diagnosis of dental caries: a European perspective.

The aim of this paper is to provide a broad international perspective on aspects of the RTI/UNC systematic review, to introduce relevant literature not cited, and to make recommendations for clinical practice education and research suggested by the evidence. Clinical caries diagnosis represents the foundation on which the answers to most of the consensus questions will be based. This paper highlights needs for being clear about definitions and nomenclature; understanding the importance of the concepts underlying the D1 and D3 diagnostic thresholds used widely within the RTI/UNC Review; and appreciating that the diagnostic challenge now faced by clinicians is significant and is becoming more complex as the presentation and distribution of the disease changes over time and the range of preventive and operative treatment options expands. A series of recommendations informed by the evidence are made, including a rather contentious issue for many clinicians concerning the lack of evidence supporting the continued use of a sharp explorer as a diagnostic tool for primary caries diagnosis. This practice should be discontinued as it may cause some harm to the patient and yet fails to provide a significant balancing diagnostic benefit. Finally, it is suggested that dentistry should learn from the developing evidence base in medicine on how best to disseminate the findings of reviews and promote appropriate changes in clinical practice.

Decision Making↗
PubMed2004

[Comparison of clinical performance of troponin T and troponin I in diagnosing acute myocardial infarction].

In this article we investigate clinical specificity and sensitivity of cardiac troponin T and cardiac troponin I tests in the patients who were admitted to the hospital with suspected acute coronary syndrome. We investigated 87 patients: the clinical investigation was performed, electrocardiogram was recorded and concentrations of cardiac troponin T and troponin I were estimated. According to the recommendations of the manufacturers of troponin T and troponin I tests, threshold diagnostic troponin T concentration for myocardial infarction was considered > or =0.1 ng/ml and troponin I > or =1.0 ng/ml. Troponin T concentration was analyzed in 60 patients; the sensitivity of troponin T test in diagnosing acute myocardial infarction was 85%, and the specificity was 87.2%. Troponin I test was performed in 46 patients; the sensitivity of the test was 76% and the specificity was 76.2%. In case when both troponin T and I tests were performed, the sensitivity of troponin T was 100% and specificity was 78% and of troponin I - respectively 86% and 78%. According to the receiver operator characteristic analysis there was no significant difference between the general accuracy of troponin T and troponin I in distinguishing patients with and without acute myocardial infarction. According to the results of receiver operator characteristic analysis, the biggest clinical sensitivity and specificity were achieved when threshold myocardial infraction diagnostic concentration of troponin T was considered >0.04 ng/ml and of troponin I >0.69 ng/ml.

Aged↗
PubMed1996

Lowering the threshold for the diagnosis of gestational diabetes.

OBJECTIVE: Our purpose was to determine whether lowering the diagnostic threshold for gestational diabetes mellitus on 3-hour 100 gm oral glucose tolerance testing will select a population at risk for adverse perinatal outcome. STUDY DESIGN: In this retrospective study 434 patients with an abnormal 50 gm glucose screen result (> or = 140 mg/dl) underwent a standardized 3-hour oral glucose tolerance test. The results were stratified according to maternal weight and the criteria recommended by Sacks or Carpenter. Birth weight and rate of macrosomia were the primary perinatal outcome variables analyzed. RESULTS: Analysis of the data set stratified according to the Sacks criteria revealed results very similar to the Carpenter criteria data set. Patients who would have been newly diagnosed with gestational diabetes mellitus only if the lowered criteria were used (group 2) were older and heavier. No other variable comparisons achieved statistical significance. When the same patients were stratified according to prepregnancy weight, overweight patients were older, gained less weight during the third trimester, underwent cesarean section more often, and had higher cumulative maternal morbidity. Regression analysis showed that the degree of hyperglycemia did not predict macrosomia or influence birth weight, but prepregnant maternal body mass index was associated with macrosomia. CONCLUSIONS: Fetal macrosomia is influenced by maternal prepregnant body mass index. Lowering the glucose tolerance test threshold would result in overdiagnosis of gestational diabetes mellitus without improving perinatal outcome.

Birth Weight↗