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

Overview

This systematic review was conducted to inform the World Health Organization (WHO) guidelines by synthesising evidence about the effects of radiofrequency electromagnetic field (RF-EMF) exposure on adverse female reproductive outcomes. A network of topic experts and methodologists comprehensively searched and assessed human observational studies focusing on outcomes such as pre-term birth, small for gestational age (SGA), miscarriage, stillbirth, low birth weight (LBW), and congenital anomalies, following established methodological guidelines.

Methods

• Extensive searching in MEDLINE, Embase, EMF Portal, and grey literature was performed.
• Inclusion criteria targeted quantitative studies of adult women exposed to RF-EMF preconception or during pregnancy.
• Blinded, duplicate data extraction, and risk of bias evaluation via the OHAT tool.
• Meta-analyses and dose-response assessments were applied as appropriate.

Findings

• 18 studies were included: 8 with general public populations (mostly mobile phone users) and 10 occupational studies (e.g., physiotherapists using shortwave diathermy).
• General public studies: Very uncertain evidence regarding RF-EMF from mobile phones and risk of preterm birth (RR 1.14), LBW (RR 1.14), or SGA (RR 1.13). Meta-analysis was not feasible for congenital anomalies or miscarriage, and the studies exhibited some risk of bias.
• Occupational studies: Ongoing uncertainty about RF-EMF exposure and miscarriage (OR 1.02), congenital malformations (OR 1.4), or other pregnancy outcomes, all with low certainty and some risk of bias.
• The certainty of evidence was generally assessed as very low due to risk of bias, confounding, and imprecision.

Interpretation & Limitations

• Substantial limitations in exposure characterisation and confounder assessment were noted, with high risk of exposure and outcome assessment bias present in most studies.
• Inconsistencies in reporting exposures and outcome measurement further limited interpretability.
• The majority of evidence was rated as low or very low-certainty. This prevents confident conclusions about the link between RF-EMF exposure and female reproductive health; however, a connection cannot be ruled out and further high-quality research is warranted.

Conclusion

While most available evidence suggests little to no effect of RF-EMF on female reproductive outcomes, the overall certainty is low due to risks of bias and small numbers of studies per outcome. The evidence does not support an increased relative risk in either general public or occupational settings, but given the potential for methodological weaknesses and underpowered studies, a health risk linked to RF-EMF exposure cannot be ruled out. More robust studies are needed to clarify any potential impacts on female reproductive health.

Open Access: Read the full study here