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\title{Authors' reply re: Maternal transmission of SARS-COV-2 to the neonate,
and possible routes for such transmission: A systematic review and
critical analysis. (Response to BJOG-20-1416)}



\author[1]{Kate Walker}%
\author[2]{Keelin ODonoghue}%
\author[3]{Nicky Grace}%
\author[4]{Jon Dorling}%
\author[4]{Jeannette Comeau}%
\author[5]{Wentao Li}%
\author[6]{James Thornton}%
\affil[1]{University of Nottingham}%
\affil[2]{University College Cork}%
\affil[3]{University of Nottingham Faculty of Arts}%
\affil[4]{Dalhousie University Faculty of Medicine}%
\affil[5]{Monash University}%
\affil[6]{Nottingham City Hospital }%


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  \date{May 17, 2024}


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Authors' reply re: 'Maternal transmission of SARS-COV-2 to the neonate,
and possible routes for such transmission: A systematic review and
critical analysis (Response to BJOG-20-1416)

Kate F Walker\textsuperscript{1}, Keelin O'Donoghue\textsuperscript{2},
Nicky Grace\textsuperscript{3}, Jon Dorling\textsuperscript{4},
Jeannette L Comeau\textsuperscript{4}, Wentao Li\textsuperscript{5} Jim
G Thornton\textsuperscript{1}

\textsuperscript{1}Division of Child Health, Obstetrics and Gynaecology,
School of Medicine, University of Nottingham

\textsuperscript{2}The Irish Centre for Maternal and Child Health,
University College Cork, Cork University Maternity Hospital, Cork,
Ireland

\textsuperscript{3} School of English, University of Nottingham

\textsuperscript{4}Department of Pediatrics, Faculty of Medicine,
Dalhousie University, Halifax, Nova Scotia, Canada

\textsuperscript{5}Department of Obstetrics and Gynaecology, Monash
University, Clayton, Australia

Thank you for the opportunity to comment on the letter by Dr Xue from
Shanghai Jiao Tong University. We agree there are many weaknesses in the
data we reviewed. Dr Xue has identified one. Others are the incomplete
reporting of infant feeding and mother-child interactions, and the
frequent lack of infant testing to confirm or refute the possibility of
vertical transmission of COVID-19. Finally, although we simply provided
summary totals, it would be statistically preferable to combine series
using the Mantel-Haenszel method and calculate a relative risk. We
judged that doing this in light of the uncertainties around the data
which Dr Xue has identified, might give a spurious precision to our
results. As he says, more work is needed. For now we think it remains
reasonable to not regard COVID-19 in itself, as an indication for
Caesarean, artificial feeding or separation, in the mother and baby's
interest.

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