ETHNIC DISPARITY IN THE PERFORMANCE OF PRENATAL NUTRITION RISK ASSESSMENT AMONG MEDICAID-ELIGIBLE WOMEN

IN THIS STUDY, the authors compare perinatal health outcomes and nutri tion risk assessments in Latina, African American, and white women rec eiving Medicaid enhanced perinatal services. The objective is to analy ze how proper assessment of obesity and underweight depend upon ethnic group, provider practice setting and credentials, and the implication s for perinatal outcomes. The medical records of women who received en hanced perinatal services from specially certified Medicaid providers in California were abstracted for information on nutrition risk assess ment and outcomes. Logistic regression analysis was used to test the a ssociations first of obesity and underweight with adverse outcomes in Latina, African American and white women, then the associations of eth nicity with the failure of-these women to be classified as overweight or underweight during assessment. Finally, the associations between mi sclassification of body mass with provider practice setting type and c redentials are also tested. Obese Latinas are twice as likely not to b e properly classified as overweight, despite evidence of substantial r isk of unfavorable outcomes. For all three ethnic groups, underweight women are uniformly underreported as being at risk The appropriate cla ssifications of obesity and underweight are not associated with privat e or public types of obstetric practice settings or whether nutrition risk assessors are registered dietitians, health workers, or nurses of any particular credential. Providers of prenatal care to low-income w omen could improve the quality of nutrition risk assessment of overwei ght Latina women and underweight women of all ethnic groups with expec tations of improving perinatal outcomes.