FOI240136: Maternity: Gestational diabetes testing

Released 10 June 2024

Request received 25 April 2024 (our reference FOI240084):

As part of a research project focusing on GDM screening and fetal outcomes, I am seeking detailed information on the following aspects:

1. Gestational Diabetes Mellitus Screening Methodology:
   Please provide details on the current methods used by your Trust to screen for Gestational Diabetes Mellitus.
2. Timing of Screening:
   At which gestational week do the majority of pregnant women undergo GDM screening within your Trust?
3. Early Screening for High-Risk Pregnancies:
   Do you conduct GDM screening earlier for pregnant women deemed to be at very high risk? If so, please specify the criteria for determining high risk and the gestational week at which such screenings are conducted.
4. Administration of OGTT:
   Who is responsible for administering the OGTT within your Trust? Additionally, where is the OGTT typically conducted (e.g., hospital clinic, community health center)?
5. Maternity-Related Risks Recorded in the Trust Risk Log:
   Please disclose which maternity-related risks are logged in the Trust’s risk register or risk log.
6. Bank and agency Spending:
   Please provide bank spend for midwifery staff for the year 2023, by job grade.
   Please provide agency spend for midwifery staff for the year 2023, by job grade.

Assistance provided to applicant under section 16 [duty to assist] on 10 May 2024:

Your enquiry was addressed to Western Sussex Hospitals NHS Foundation Trust. Please note that University Hospitals Sussex NHS Foundation Trust has been in operation since 1 April 2021, following the merger of Brighton and Sussex University Hospitals NHS Trust and Western Sussex Hospitals NHS Foundation Trust.

Information about the Trust’s hospitals can be found on our website.

It is also important to note that the Trust offers a multi-site maternity service and information about the Trust’s maternity services and maternity units can be found on our website.

With the above in mind, are you seeking Trust-wide information or information specifically relevant to the hospitals under former Western Sussex Hospitals NHS Foundation Trust?

Regarding question 6, limitations in our financial reporting mean that we are able to provide Trust-wide figures relevant to financial years only. Can you please confirm that information for the financial year 2023/24 (April 2023 – March 2024) will be an acceptable alternative?

Reply received from applicant on 10 May 2024:

I would appreciate Trust-wide information. Regarding question 6, the information for the financial year 2023/24 is acceptable.

In line with the section 45 FOI Code of Practice, the request was allocated a new reference number (our reference FOI240136) and the statutory deadline reset.

Information disclosed:

Our response relative to the maternity units at Royal Sussex County Hospital (RSCH),  Brighton and Princess Royal Hospital (PRH), Haywards Heath is provided below:

1. Anyone with a risk factor (see question 3) is offered an HbA1c blood test when booking at 14 weeks. If the HbA1c result is 41 or more the patient will be offered a glucose test to confirm diagnosis. If the  patient has had previous Gestational Diabetes Mellitus (GDM) but has normal HbA1c, they will be offered a glucose test around 14 weeks and 26 weeks. All other risk factors normal HbA1c offered a glucose test at 26 weeks. Should a patient have emerging risk factors (glycosuria, polyhydramnios, macrosomia) in 3rd trimester they will be offered a glucose test. Over 36 weeks we offer HbA1c – if 39 or more we treat as having GDM.
2. The majority of patients are tested at 26 weeks.
3. Yes, patients classed as high risk include: previous GDM; BMI over 30; age over 40; previous baby over 4.5kg; ethnic origin outside Europe; first degree relative with diabetes; known twin pregnancy; patients with polycystic ovary syndrome; patients on antipsychotic meds and previous stillbirth.
4. At RSCH and PRH the majority of the OGTT tests are performed by the phlebotomy department in Outpatients; at RSCH there is also an overflow clinic in antenatal clinic which is staffed by midwives and maternity care assistants. Overall the majority of these tests are performed within the hospital environment.

Our response relative to the maternity units at St Richard’s Hospital, Chichester and Worthing Hospital, Worthing is provided below:

1. Oral Glucose tolerance tests are used to diagnose GDM up until 36 weeks. After 36 weeks we take a HbA1c and if equal to or above 39mmolsmmols we treat as if had late onset GDM and would follow GDM pathway in labour and for the newborn.

2. Patients at high risk of GDM are tested at booking (before 14 weeks) and other patients are tested at 26 weeks using OGTT.

3. Yes, patients classed as high risk include: family history of diabetes; BMI over 30; age over 40yrs; multiple pregnancy; polycystic ovary syndrome; ethnicity (from high risk groups as per NICE); previous stillbirth; previous GDM; previous baby over 4.5kg.

4.OGTT tests are generally carried out in the community, either by a GP surgery or family centre and are run by a maternity health care assistant. They will also be done in the antenatal clinic if needed by HCA/midwife and occasionally in the pathology lab if the patient is difficult to draw blood from.

Our response relative to the maternity units under University Hospitals Sussex NHS Foundation Trust is provided below:

5. Please see attached document “FOI240136 – Risk register details.pdf” for information relevant to this part of you request.

6. Please see below for details of spend by band on maternity staff across the Trust in financial year 2023/24:

• Band 5 Bank – £124,886.60 
• Band 6 Bank – £1,002,959.07
• Band 7 Bank – £320,419.13
• Band 8A Bank – £16,945.05
• Band 8B Bank – £3,532.98
• Agency spend – £0 (nil)

Attachment:

FOI240136 – Risk register details (71kB pdf)