
Paul T SeedKing's College London | KCL · Division of Women's Health
Paul T Seed
MSc (Medical Statistics)
About
666
Publications
143,151
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Introduction
The appliance of statistical and biometric methods to the solution of real clinical and public health problems.
Additional affiliations
November 2001 - January 2003
March 2009 - present
October 1991 - January 1996
Education
September 1990 - June 1991
September 1980 - June 1981
September 1979 - June 1981
Publications
Publications (666)
Background
Dietary behaviours in early life often track across the life course, influencing the development of adverse health outcomes such as obesity and cardiovascular disease. This study aimed to explore the between dietary patterns (DP) in preschool children and maternal DP and family eating habits.
Methods
We conducted a secondary analysis of...
Background/Objectives
Maternal obesity is associated with a decreased intention and initiation of breastfeeding as well as a shortened duration of breastfeeding. This analysis was undertaken to identify breastfeeding behaviours, and relationships with maternal anthropometry and the serum metabolome at 6-months postpartum in an ethnically diverse co...
Serial prophylactic exchange blood transfusion (SPEBT) is increasingly used in sickle cell disease (SCD) pregnancy, despite a lack of robust evidence. The Transfusion Antenatally in Pregnant Women with Sickle Cell Disease (TAPS2) study assessed the feasibility and acceptability of conducting a definitive randomized controlled trial of SPEBT (interv...
Objectives
This study identifies the most common recorded reason for attendance to primary care for children under 5 years old, including a breakdown via age, ethnicity, deprivation quintile and sex.
Design
Cross-sectional.
Setting
39 of 40 general practices in Lambeth, London, UK.
Participants
22 189 children under 5 years who had attended prim...
BACKGROUND
Preterm preeclampsia is a pregnancy complication associated with myocardial dysfunction and premature cardiovascular disease morbidity and mortality. Left atrial (LA) strain is a noninvasive index of left ventricular end diastolic pressure and an early marker of heart failure risk. This study aimed to evaluate LA strain during the postpa...
BACKGROUND
PlGF (placental growth factor)-based testing reduces severe maternal adverse outcomes. Repeat PlGF-based testing is not associated with improved perinatal or maternal outcomes. This planned secondary analysis aimed to determine whether there is a subgroup of women who benefit from repeat testing.
METHODS
Pregnant individuals with suspec...
Background
Sierra Leone has a very high maternal mortality rate, and this burden falls heavily on adolescents, a particularly vulnerable group; this is usually driven by poverty, lack of education and employment opportunities. In 2017, a local grassroots organisation, Lifeline Nehemiah Projects, developed a community-based mentoring intervention ‘2...
Studies suggest that inducing gut microbiota changes may alter both muscle physiology and cognitive behaviour. Gut microbiota may play a role in both anabolic resistance of older muscle, and cognition. In this placebo controlled double blinded randomised controlled trial of 36 twin pairs (72 individuals), aged ≥60, each twin pair are block randomis...
Objective
Investigation of serum bile acid profiles in pregnancies complicated by gestational diabetes mellitus (GDM) in a multi‐ethnic cohort of women who are lean or obese.
Design
Prospective cohort study.
Setting
UK multicentre study.
Population
Fasting serum from participants of European or South Asian self‐reported ethnicity from the PRiDE...
(Abstracted from Lancet 2023; 402:386–396)
Preeclampsia is a disorder of pregnancy that proposes a disproportionately high risk to women in low- and middle-income countries (LMICs); it is one of the leading causes of maternal morbidity and mortality worldwide and is estimated to have an annual death toll of greater than 40,000. The only treatment w...
Aim
There is currently limited evidence on the costs associated with late preterm pre-eclampsia beyond antenatal care and post-natal discharge from hospital. The aim of this analysis is to evaluate the 24-month cost-utility of planned delivery for women with late preterm pre-eclampsia at 34 ⁺⁰ and 36 ⁺⁶ weeks’ gestation compared to expectant manage...
Objective
To assess the diagnostic performance of angiogenic biomarkers in determining need for delivery in seven days in women with late preterm preeclampsia.
Study design
In a prospective observational cohort study in 36 maternity units across England and Wales, we studied the diagnostic accuracy of placental growth factor (PlGF) and sFlt-1 in d...
Objective
We evaluated the best time to initiate delivery in late preterm pre-eclampsia in order to optimise long-term infant and maternal outcomes.
Design
Parallel-group, non-masked, randomised controlled trial.
Setting
46 UK maternity units.
Population
Women with pre-eclampsia between 34 ⁺⁰ and 36 ⁺⁶ weeks’ gestation, without severe disease, w...
Introduction
Spontaneous preterm birth prior to 32 weeks' gestation accounts for 1% of all deliveries and is associated with high rates of morbidity and mortality. A total of 70% are associated with chorioamnionitis which increases the incidence of morbidity, but for which there is no noninvasive antenatal test. Fetal adrenal glands produce cortiso...
Background
Sierra Leone has a very high maternal mortality rate, and this burden falls heavily on adolescents, a particularly vulnerable group; this is usually driven by poverty, lack of education and employment opportunities. In 2017, a local grassroots organisation, Lifeline Nehemiah Projects, developed a community-based mentoring intervention ‘2...
Background The benefits of using low-field-strength fetal MRI to evaluate antenatal development include reduced image artifacts, increased comfort, larger bore size, and potentially reduced costs, but studies about fetal low-field-strength MRI are lacking. Purpose To evaluate the reliability and feasibility of low-field-strength fetal MRI to assess...
Background
The CRADLE Vital Signs Alert intervention (an accurate easy-to-use device that measures blood pressure and pulse with inbuilt traffic-light early warning system, and focused training package) was associated with reduced rates of eclampsia and maternal death when trialled in urban areas in Sierra Leone. Subsequently, implementation was su...
Background:
Early delivery in preterm preeclampsia may reduce the risks for the patient, but consequences of prematurity may be substantial for the baby. This trial evaluated whether the implementation of a risk stratification model could safely reduce prematurity.
Methods:
This was a stepped-wedge cluster-randomized trial in seven clusters. Pat...
Background
The CRADLE Vital Signs Alert intervention (an accurate easy-to-use device that measures blood pressure and pulse with inbuilt traffic-light early warning system, and focused training package) was associated with reduced rates of eclampsia and maternal death when trialled in urban areas in Sierra Leone. Subsequently, implementation was su...
Background:
Pre-eclampsia is a leading cause of maternal and perinatal mortality. Evidence regarding interventions in a low-income or middle-income setting is scarce. We aimed to evaluate whether planned delivery between 34+ 0 and 36+ 6 weeks' gestation can reduce maternal mortality and morbidity without increasing perinatal complications in India...
Background:
Cervical cerclage has been shown to reduce the risk of recurrent spontaneous preterm birth in a high-risk patient population, however the mechanism is not well understood. Transabdominal cerclage is superior to low and high vaginal cerclage in reducing early spontaneous preterm birth and fetal loss in women with previous failed vaginal...
Objective
To determine severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) seroprevalence in pregnancy in an inner‐city setting and assess associations with demographic factors and vaccination timing.
Design
Repeated cross‐sectional surveillance study.
Setting
London maternity centre.
Sample
A total of 906 pregnant women attending nucha...
Background
There are significant knowledge gaps regarding the effectiveness of serial prophylactic exchange blood transfusion (SPEBT) for pregnant women with sickle cell disease (SCD). The protocol for the randomised feasibility trial assessing SPEBT versus usual care in women with SCD (TAPS2 trial) has previously been published. This publication o...
Objective:
The study aim was to examine the relationships between longitudinal dietary trajectories from early pregnancy to 3 years post delivery and adiposity measures in women with obesity.
Methods:
The diets of 1208 women with obesity in the UPBEAT (UK Pregnancy Better Eating and Activity Trial) study were assessed using a food frequency ques...
Background:
The mainstay of assessment of the fetal lungs in clinical practice is via evaluation of pulmonary size, primarily using 2D ultrasound and more recently with anatomical MRI. The emergence of advanced MR techniques such as T2* relaxometry in combination with the latest motion correction post-processing tools now facilitates assessment of...
Background:
Bacterial vaginosis (BV) increases preterm delivery (PTD) risk, but treatment trials showed mixed results in preventing PTD.
Objectives:
Determine, using individual participant data (IPD), whether BV treatment during pregnancy reduced PTD or prolonged time-to-delivery.
Data sources:
Cochrane Systematic Review (2013), MEDLINE, EMBAS...
Bidibidi Refugee Settlement's 223,000 refugees are vulnerable to malaria due to crowded conditions and limited healthcare access. Early identification and referral of suspected cases is key to reduce morbidity and mortality. We evaluated the shock index (heart rate/ systolic blood pressure) for detection of abnormal vital signs, calculated by the C...
Objectives:
To determine the performance of predictive markers of spontaneous preterm birth, cervicovaginal quantitative fetal fibronectin and cervical length, in asymptomatic high-risk women with transabdominal, history-indicated and ultrasound-indicated cerclage.
Methods:
This was a secondary analysis of a prospectively collected cohort of hig...
Background
The development and evaluation of specific maternity care packages designed to address preterm birth remains a public health priority. We aim to evaluate the implementation, context, and potential mechanisms of action, of a new care pathway that combined midwifery continuity of care with a specialist obstetric clinic for women at risk of...
Background:
The CRADLE (Community blood pressure monitoring in Rural Africa: Detection of underLying pre-Eclampsia) Vital Signs Alert device-designed specifically to improve maternity care in low resource settings-had varying impact when trialled in different countries. To better understand the contextual factors that may contribute to this variat...
Fetal long-QT syndrome (LQTS) may present with sinus bradycardia, functional 2:1 atrioventricular block (2:1AVB), and ventricular arrhythmias (VT/TdP) and lead to fetal or postnatal death. We performed a systematic review and individual participant data meta-analysis of 83 studies reporting outcomes of 265 fetuses where suspected LQTS was confirmed...
Background
In women with late preterm pre-eclampsia (i.e. at 34 ⁺⁰ to 36 ⁺⁶ weeks’ gestation), the optimal delivery time is unclear because limitation of maternal–fetal disease progression needs to be balanced against infant complications. The aim of this trial was to determine whether or not planned earlier initiation of delivery reduces maternal...
Synopsis
The authors found a strong correlation between national‐level data for deaths from household pollution and eclampsia rates in the CRADLE 3 (Community Blood Pressure Monitoring in Rural Africa & Asia: Detection of Underlying Pre‐Eclampsia and Shock) study clusters (correlation coefficient: 0.84).
Background/Objectives
Obesity in pregnancy has been associated with increased childhood cardiometabolic risk and reduced life expectancy. The UK UPBEAT multicentre randomised control trial was a lifestyle intervention of diet and physical activity in pregnant women with obesity. We hypothesised that the 3-year-old children of women with obesity wou...
Antenatal corticosteroids (ACS) are an established intervention to improve outcomes in preterm birth. ACS are optimally timed if the administration-to-birth interval is greater than 24 hours and less than 7 days. Evidence has emerged suggesting harm associated with administration-to-birth intervals greater than seven days, or with repeated courses...
Background
Pre-eclampsia is a complex pregnancy disorder, characterised by new or worsening hypertension associated with multi-organ dysfunction. Adverse outcomes include eclampsia, liver rupture, stroke, pulmonary oedema, and acute kidney injury in the mother, and stillbirth, foetal growth restriction, and iatrogenic preterm delivery for the foetu...
Background
Many women with chronic hypertension are conflicted about antihypertensive medication during pregnancy and some are non-adherent to prescribed medication.
Objectives
Codesign, implement and evaluate a novel shared decision-making (SDM) intervention for use with pregnant women with chronic hypertension.
Setting and participants: Pregnant...
Background
Pre-eclampsia is a complex pregnancy disorder, characterised by new or worsening hypertension associated with multi-organ dysfunction. Adverse outcomes include eclampsia, liver rupture, stroke, pulmonary oedema, and acute kidney injury in the mother, and stillbirth, fetal growth restriction, and iatrogenic preterm delivery for the fetus....
Objectives
The ability to predict spontaneous PTB (sPTB) has improved greatly, allowing women at risk to be managed with prophylactic interventions such as cervical cerclage and the Arabin pessary. Cervicovaginal fetal fibronectin (fFN) concentration and ultrasound measurement of Cervical length (CL) are the two most established tools to predict sP...
Introduction
One in 10 women have hypertensive disorders in pregnancy (HDP) and are at risk of adverse short- and long-term health outcomes, yet there is limited information on their postnatal health and care needs. This study aimed to look at postnatal physical and psychological morbidity in women with HDP, compared to women without HDP, and the p...
Objective
Pregnancy hypertension is a leading cause of maternal and perinatal mortality and morbidity. Between 34⁺⁰ and 36⁺⁶ weeks’ gestation, it is uncertain whether planned delivery could reduce maternal complications without serious neonatal consequences. In this individual participant data meta-analysis (IPD-MA) we aim to compare planned delive...
Background
Obesity in pregnancy increases the risk of gestational diabetes mellitus (GDM) and associated adverse outcomes. Despite metabolic differences, all pregnant women with obesity are considered to have the same risk of developing GDM. Improved risk stratification is required to enable targeted intervention in women with obesity who would ben...
Serum progesterone sulfates were evaluated in the etiology of gestational diabetes mellitus (GDM).
Serum progesterone sulfates were measured using ultra-performance liquid chromatography-tandem mass spectrometry in four patient cohorts: 1) the Hyperglycemia and Adverse Pregnancy Outcomes study; 2) London-based women of mixed ancestry and 3) UK-base...
Objectives
The objective of this study was to explore and validate thresholds for Placental growth factor (PlGF) and soluble fms-like tyrosine-kinase 1 (s-Flt-1) (as s-Flt-1:PlGF ratio), to rule-in and rule-out disease in women with suspected pre-eclampsia, using DELFIA® Xpress PlGF1-2-3 and sFlt-1 assays.
Study Design
369 samples from women with s...
Background
As the vast majority of women who present in threatened preterm labour (TPTL) will not deliver early, clinicians need to balance the risks of over-medicalising the majority of women, against the potential risk of preterm delivery for those discharged home. The QUiPP app is a free, validated app which can support clinical decision-making...
Background
Maternal obesity may increase offspring risk of cardiovascular disease. We assessed the impact of maternal obesity on cardiac structure and function in newborns as a marker of fetal cardiac growth.
Methods
Neonates born to mothers of healthy weight (body mass index (BMI) 20–25 kg/m ² , n=56) and to mothers who were obese (BMI ≥30 kg/m ²...
Objectives
(1) To report maternal and newborn outcomes of pregnant women in areas of social deprivation in inner city London. (2) To compare the effect of caseload midwifery with standard care on maternal and newborn outcomes in this cohort of women.
Design
Retrospective observational cohort study.
Setting
Four council wards (electoral districts)...
This secondary analysis of the PHOENIX trial (evaluating planned delivery against expectant management in late preterm preeclampsia) demonstrates that in women who started induction of labour, 63% of women delivered vaginally (56% at 34 weeks’ gestation). Compared to expectant management, planned delivery was associated with higher rates of neonata...
Background
Obesity in pregnancy increases the risk of gestational diabetes mellitus (GDM) and associated adverse outcomes. Despite metabolic differences, all pregnant women with obesity are considered to have the same risk of developing GDM. Improved risk stratification is required to enable targeted intervention in women with obesity who would ben...
Background
Women whose pregnancies are affected by hypertensive disorders of pregnancy, in particular preterm pre-eclampsia, are at increased risk of long-term cardiovascular morbidity and mortality.
Objectives
To investigate the hypothesis that prolongation of a pregnancy affected by preterm pre-eclampsia managed by expectant management compared...
(Abstracted from Lancet Gastroenterol Hepatol 2021;6:547–558)
Ursodeoxycholic acid (UA) is a common treatment for intrahepatic cholestasis of pregnancy (ICP), and its use is supported by the Society for Maternal-Fetal Medicine. However, evidence of the benefit of UA to fetal and neonatal outcomes in this patient population is unclear.
This study evaluated whether planned early delivery would ameliorate cardiovascular dysfunction 6 months postpartum, compared with usual care with expectant management, in women with late preterm preeclampsia. We conducted a mechanistic observational study in women with preterm preeclampsia between 34 ⁺⁰ and 36 ⁺⁶ weeks’ gestation, nested within a...
Objective:
Stillbirth is a potentially preventable complication of pregnancy. Identifying women at risk can guide decisions on closer surveillance or timing of birth to prevent fetal death. Prognostic models have been developed to predict the risk of stillbirth, but none have yet been externally validated. We externally validated published predict...
The syndrome of spontaneous preterm birth (sPTB) presents a challenge to mechanistic understanding, effective risk stratification, and management. Individual associations between sPTB, ethnicity, vaginal microbiota, metabolome and innate immune response are known, but not fully understood and knowledge has yet to impact clinical practice. Here we u...
Background
Preterm delivery (before 37 weeks of gestation) is the single most important contributor to neonatal death and morbidity, with lifelong repercussions. However, the majority of women who present with preterm labour (PTL) symptoms do not deliver imminently. Accurate prediction of PTL is needed in order ensure correct management of those mo...
Objective:
To validate the BPro blood pressure (BP) wrist device for use in pregnancy and preeclampsia according to the Universal Standard protocol.
Participants and methods:
BP was measured sequentially in 45 pregnant women (including 15 with preeclampsia, 15 with gestational hypertension and 15 who remained normotensive) alternating between a...
Pregnancy can alter a woman’s weight gain trajectory across the life course and contribute to the development of obesity through retention of weight gained during pregnancy. This study aimed to identify modifiable determinants associated with postpartum weight retention (PPWR; calculated by the difference in pre-pregnancy and 6 month postpartum wei...
Background
Children born to mothers with obesity are at increased risk of obesity. Influences underlying this predisposition include in‐utero exposures, genetic predisposition and a shared family environment. Effective intervention strategies are needed to prevent obesity in these high‐risk children; this requires evaluation of modifiable pregnancy...
Background
Pre-eclampsia affects around 2–3% of all pregnancies, and is associated with potential serious complications for the woman and the baby. Once diagnosed, progression of the syndrome can be unpredictable, and decisions around timing of delivery need to take into account evolving maternal complications and perinatal morbidity. Novel prognos...
Background Ursodeoxycholic acid is commonly used to treat intrahepatic cholestasis of pregnancy, yet its largest trial
detected minimal benefit for a composite outcome (stillbirth, preterm birth, and neonatal unit admission). We aimed
to examine whether ursodeoxycholic acid affects specific adverse perinatal outcomes.
Methods In this systematic rev...
Background
Midwifery continuity of care models for women at low and mixed risk of complications have been shown to improve women’s experiences of care. However, there is limited research on care experiences among women at increased risk of preterm birth. We aimed to explore the experiences of care among women with risk factors for preterm birth par...
Background
Obstetric haemorrhage is the leading cause of maternal death worldwide, 99% of which occur in low and middle income countries. The majority of deaths and adverse events are associated with delays in identifying compromise and escalating care. Management of severely compromised pregnant women may require transfer to tertiary centres for s...
Recent studies implicate maternal gestational diabetes mellitus (GDM) in differential methylation of infant DNA. Folate and vitamin B12 play a role in DNA methylation, and these vitamins may also influence GDM risk. The aims of this study were to determine folate and vitamin B12 status in obese pregnant women and investigate associations between fo...
Objective:
To determine the optimal total serum bile acid (TSBA) threshold and sampling time for accurate intrahepatic cholestasis of pregnancy (ICP) diagnosis.
Design:
Case-control, retrospective cohort studies.
Setting:
Antenatal clinics, clinical research facilities.
Population:
Women with ICP or uncomplicated pregnancies.
Methods:
Seri...