Fuentes-Afflick E, Korenbrot C C, Greene J
University of California, San Francisco, USA.
Public Health Rep. 1995 Nov-Dec;110(6):764-73.
In this study, the authors compare perinatal health outcomes and nutrition risk assessments in Latina, African American, and white women receiving Medicaid enhanced perinatal services. The objective is to analyze how proper assessment of obesity and underweight depend upon ethnic group, provider practice setting and credentials, and the implications for perinatal outcomes. The medical records of women who received enhanced perinatal services from specially certified Medicaid providers in California were abstracted for information on nutrition risk assessment and outcomes. Logistic regression analysis was used to test the associations first of obesity and underweight with adverse outcomes in Latina, African American and white women, then the associations of ethnicity with the failure of these women to be classified as overweight or underweight during assessment. Finally, the associations between misclassification of body mass with provider practice setting type and credentials are also tested. Obese Latinas are twice as likely not to be properly classified as overweight, despite evidence of substantial risk of unfavorable outcomes. For all three ethnic groups, underweight women are uniformly underreported as being at risk. The appropriate classifications of obesity and underweight are not associated with private 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 women could improve the quality of nutrition risk assessment of overweight Latina women and underweight women of all ethnic groups with expectations of improving perinatal outcomes.
在本研究中，作者比较了接受医疗补助强化围产期服务的拉丁裔、非裔美国人和白人女性的围产期健康结局和营养风险评估。目的是分析肥胖和体重不足的正确评估如何取决于种族、医疗服务提供者的执业环境和资质，以及对围产期结局的影响。从加利福尼亚州经过特殊认证的医疗补助提供者处接受强化围产期服务的女性的病历被提取，以获取营养风险评估和结局方面的信息。使用逻辑回归分析首先测试拉丁裔、非裔美国人和白人女性中肥胖和体重不足与不良结局之间的关联，然后测试种族与这些女性在评估期间未被归类为超重或体重不足之间的关联。最后，还测试了体重分类错误与医疗服务提供者执业环境类型和资质之间的关联。尽管有证据表明肥胖的拉丁裔女性有很大的不良结局风险，但她们未被正确归类为超重的可能性是其他人的两倍。对于所有三个种族群体，体重不足的女性被统一少报为有风险。肥胖和体重不足的适当分类与产科执业环境的私立或公立类型无关，也与营养风险评估人员是否是注册营养师、卫生工作者或具有任何特定资质的护士无关。为低收入女性提供产前护理的医疗服务提供者可以提高超重拉丁裔女性和所有种族体重不足女性的营养风险评估质量，以期改善围产期结局。
