Discussion
Physiological adaptive changes, increased oxygen consumption, and
suppressed immune state increase the susceptibility of pregnant women to
respiratory pathogens and pneumonia1. Previous reports
have shown that HPV, HIV, and other viruses are related to increased
rate of preterm birth2,3. However, whether preterm
delivery described in this report was caused by SARS-CoV-2 remains
unknown. The case in the present report is a pregnant woman infected
with COVID-19 that rapidly developed into severe respiratory infection
following vaginal delivery. Since there is only one case in the present
report, it is difficult to draw conclusions with regard to the etiology
of the symptoms after vaginal delivery. Whether the strong contractions
during natural delivery can exacerbate pneumonia associated with
COVID-19 still needs to be confirmed. Huijun et. al. have
reported that none of nine confirmed patients infected with SARS-CoV-2
developed severe COVID-19 pneumonia or died after the caesarean section
in their third trimester4, suggesting that cesarean
section may carry less risk in pregnant women infected with SARS-CoV-2.
Due to the increased oxygen consumption and pulmonary load during
pregnancy, cesarean section may help to avoid adverse clinical
consequences caused by pulmonary insufficiency and also reduces the
possibility of maternal viremia during delivery. In addition, we didn’t
observe any abnormalities from the newborn baby, which indicated no
mother-to-child transmission by vaginal delivery. This observation was
consistent with Huijun and colleagues’ finding of no intrauterine
transmission of COVID-19.