Strengths and Limitations
The most important strength of the study is the first trial, which
elucidated the relation of SARS-CoV-2 infection with the composition of
vaginal flora. The vaginal samples were comprehensively collected from
the healthy controls and women with COVID-19 disease. The samples from
vaginal flora were analyzed exclusively by the three doctors in the
group. Furthermore, we had longitudinal samples from three pregnant
women, which provided an opportunity for comparison of vaginal
composition of pregnant women before and after the disease. Further,
detailed clinical data were collected from each participant and reported
to consider for an evaluation of each subject.
There are several limitations. Our sample size was small to detect the
statistical significance between women with severe COVID-19 and women
with asymptomatic or mild disease, albeit with some significant
differences. Secondly, a potential confounding factor that may differ
among the groups was the use of antibiotics in the severe cases during
the active stage at the time of sample collection.