<div>Sir,&nbsp;</div><div>We read with interests the article by Kate F Walker and colleagues,
entitled ”Maternal transmission of SARS-COV-2 to the neonate, and
possible routes for such transmission: A systematic review and critical
analysis”. We would like to discuss some points that merit further.</div><div>In the article, the authors systematically analyzed the mode of delivery
on the infection rates of COVID-19 of newborn, they found that the
infection rate is no greater when the baby is born vaginally, breastfed
or allowed contact with the mother, compared with those performed with
Caesarean sections.</div><div>Despite the limitations, especially the retrospective feature, this
study provided important information for the selection of mode of
delivery with COVID-19, that Caesarean birth was not better than
virginal delivery on neonatal infection outcomes.</div><div>However, the main defect was the lacking severity evaluation of COVID-19
of the mothers, which may result in selective bias, or even alter the
conclusion. Clinically, pregnant women combined with more&nbsp;severe degrees
of COVID-19 always prefer Caesarean delivery than virginal delivery.
Possibility was that the protective effects of Cesarean birth might have
been neutralized by the severity of COVID-19.</div><div>COVID-19 is a kind of highly contagious respiratory virus, Both the
patients and doctors feel anxious about the possible increased infection
risk during the second stage of the labor, for the virginal labor
usually takes longer than Caesarean.</div><div>Considering the above, prospective evaluation the safety of mode of
delivery with COVID-19 would have important significance for clinical
practice.</div><div>Rui-hong Xue<sup>1</sup></div><div><sup>1</sup>Department of Obstetrics and Gynecology,
International Peace Maternity and Child Health Hospital, School of
Medicine, Shanghai Jiao Tong University, Shanghai, China</div>