The effects of radiofrequency exposure on adverse female reproductive outcomes: A systematic review of human observational studies with dose-response meta-analysis (WHO SR 3 female)

Authors: Johnson EE, Kenny RPW, Adesanya AM, Richmond C, Beyer F, Calderon C, Rankin J, Pearce MS, Toledano M, Craig D, Pearson F

Year: 2024 Jun 12

Category: Epidemiology

Journal: Environmental International

DOI: 10.1016/j.envint.2024.108816

URL: https://www.sciencedirect.com/science/article/pii/S0160412024004021

Abstract

Overview

To support the development of radiofrequency electromagnetic field (RF-EMF) exposure guidelines, the World Health Organization (WHO) initiated a comprehensive evidence-gathering process targeting health outcomes prioritized by expert consensus. This systematic review, designed to align with the WHO handbook for guideline development and COSTER conduct guidelines, evaluates the impact of RF-EMF exposure on adverse pregnancy outcomes in human observational studies.

Methods

  • A thorough search of MEDLINE, Embase, and EMF Portal databases was conducted; grey literature and expert consultations further enhanced the coverage.
  • The review focused on quantitative human observational studies examining RF-EMF exposure (from preconception through pregnancy) and outcomes such as pre-term birth, small for gestational age (SGA), miscarriage, stillbirth, low birth weight (LBW), and congenital anomalies.
  • Data screening and extraction were performed in duplicated, blinded fashion, with risk-of-bias assessed via the OHAT tool and certainty in evidence via the OHAT GRADE tool.
  • Meta-analyses compared the highest versus lowest exposures and included dose-response assessments where possible.

Findings

  • Overall: 18 studies were identified (8 general public studies, 10 occupational).
  • General public studies: Very low-certainty evidence about RF-EMF exposure from mobile phones and adverse reproductive outcomes such as preterm birth, LBW, and SGA.
  • Meta-analysis results:
    • Preterm birth risk: RR 1.14 (95% CI: 0.97–1.34)
    • LBW: RR 1.14 (95% CI: 0.96–1.36)
    • SGA: RR 1.13 (95% CI: 1.02–1.24)
  • No general public studies assessed stillbirth; effects on congenital anomalies or miscarriage showed variable, uncertain findings and risk of bias.
  • Occupational studies: Focused on physiotherapists exposed to RF-EMF (shortwave diathermy), radar, and similar sources, found very low-certainty evidence about risks of miscarriage and congenital anomalies. Quantitative synthesis provided:
    • Miscarriage: OR 1.02 (95% CI 0.94–1.1)
    • Congenital malformations: OR 1.4 (95% CI 0.85–2.32)
  • Evidence on stillbirth, SGA was inconsistent and could not be meta-analyzed.

Conclusion

The collective evidence remains very uncertain regarding the effect of RF-EMF exposure on female reproductive outcomes, both in general population and occupational settings. Importantly, these findings do indicate a possible connection between EMF exposure and adverse reproductive health outcomes, highlighting the need for caution and the necessity of further, rigorously designed prospective research to clarify these effects.

radiofrequency EMF reproductive health female pregnancy outcomes miscarriage systematic review
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