Effect of electromagnetic Effect of electromagnetic waves of cellular phones waves of cellular phones on fetal blood flow and on fetal blood flow and heart rate patterns: a heart rate patterns: a

pilot studypilot study

Thesis presented byThesis presented byAmr Hazim Abbassy M.B, B.ChAmr Hazim Abbassy M.B, B.Ch

Supervised bySupervised byProf. Dr. Ismaeel Foad Al-AseilyProf. Dr. Ismaeel Foad Al-Aseily

Assistant Professor Dr. Osama Mahmoud AzmyAssistant Professor Dr. Osama Mahmoud AzmyAssistant Prof Dr.Foad Abdelqader AbohemelaAssistant Prof Dr.Foad Abdelqader Abohemela

Question: “Doctor, is it safe Question: “Doctor, is it safe to use the mobile phone to use the mobile phone

during pregnancy?”during pregnancy?”

Scientific BackgroundScientific Background

Increased use of cellular phones Increased use of cellular phones during pregnancy while little is during pregnancy while little is known about their hazards.known about their hazards.

Proximity of the fetus to cell phone Proximity of the fetus to cell phone during transport and use.during transport and use.

Studies indicate that there might be Studies indicate that there might be health hazards at non-thermal levels health hazards at non-thermal levels as well as behavioral disorders in as well as behavioral disorders in the offspring.the offspring.

Scientific Background Scientific Background continuedcontinued

Cellular phones emit Cellular phones emit microwave radiation in the microwave radiation in the spectrum region of 800-900 spectrum region of 800-900 MHzMHz

The rate at which radiation The rate at which radiation is absorbed is measured by is absorbed is measured by the Specific Absorption the Specific Absorption Rate (SAR).Rate (SAR).

Currently, it is difficult to Currently, it is difficult to measure the amount ELF measure the amount ELF absorbed by the fetus due absorbed by the fetus due to cellular phone use.to cellular phone use.

Aim of the workAim of the work

To assess the effect of cellular To assess the effect of cellular phones on pregnancy.phones on pregnancy.

To provide guidelines and safety To provide guidelines and safety measures for using the technology measures for using the technology during pregnancy.during pregnancy.

To provide an addition to the To provide an addition to the growing research done worldwide growing research done worldwide on the possible health hazards of on the possible health hazards of this relatively new technology.this relatively new technology.

The Fetal Heart RateThe Fetal Heart Rate

Electronic fetal heart rate monitoring is Electronic fetal heart rate monitoring is commonly used to assess fetal well-being commonly used to assess fetal well-being

The fetal heart rate undergoes constant The fetal heart rate undergoes constant and minute adjustments in response to and minute adjustments in response to the fetal environment and stimuli. the fetal environment and stimuli.

The FHR is controlled by the autonomic The FHR is controlled by the autonomic nervous system. The inhibitory influence nervous system. The inhibitory influence on the heart rate is conveyed by the vagus on the heart rate is conveyed by the vagus nerve, whereas excitatory influence is nerve, whereas excitatory influence is conveyed by the sympathetic nervous conveyed by the sympathetic nervous system. system.

The Fetal Heart Rate The Fetal Heart Rate continuedcontinued

The normal FHR range The normal FHR range is between 120 and 160 is between 120 and 160 beats per minute (bpm). beats per minute (bpm).

Fetal heart rate Fetal heart rate patterns are classified patterns are classified as reassuring, as reassuring, nonreassuring or nonreassuring or ominous.ominous.

Reassuring patterns Reassuring patterns correlate well with a correlate well with a good fetal outcome, good fetal outcome, while nonreassuring while nonreassuring patterns do not. patterns do not.

Doppler UltrasoundDoppler Ultrasound

Doppler US offers a unique Doppler US offers a unique noninvasive technology for noninvasive technology for investigating the circulatory investigating the circulatory system.system.

Doppler US velocimetry has Doppler US velocimetry has been extensively used to been extensively used to investigate fetal, investigate fetal, fetoplacental, and fetoplacental, and uteroplacental circulations. uteroplacental circulations.

There is ample evidence There is ample evidence associating abnormal Doppler associating abnormal Doppler findings with complications of findings with complications of pregnancy and an adverse pregnancy and an adverse perinatal outcome as in perinatal outcome as in multiple gestations, fetal multiple gestations, fetal anemia, fetal IUGR, and fetal anemia, fetal IUGR, and fetal congenital heart diseases.congenital heart diseases.

The Body is an Electrical The Body is an Electrical OrganismOrganism

HeartbeatHeartbeat

BrainwavesBrainwaves

Cell DivisionCell Division

Health Effects from Health Effects from exposure to exposure to

electromagnetic fieldselectromagnetic fields Expanding use of cellular technology Expanding use of cellular technology

has led to some speculations that has led to some speculations that ‘electromagnetic pollution’ is causing ‘electromagnetic pollution’ is causing significant risks to human health.significant risks to human health.

The amount of energy absorbed by The amount of energy absorbed by the body is called the ‘Specific the body is called the ‘Specific Absorption Rate’ expressed in Absorption Rate’ expressed in (W/Kg).(W/Kg).

Biological effects that result from Biological effects that result from heating of tissues by RF energy are heating of tissues by RF energy are referred to as “thermal” effects.referred to as “thermal” effects.

However studies indicate that However studies indicate that biological effects may be caused biological effects may be caused without heating of tissues referred to without heating of tissues referred to as “non-thermal effect”as “non-thermal effect”

Health Effects from Health Effects from exposure to exposure to

electromagnetic fields cont.electromagnetic fields cont. The ‘thermal’ effect is the principle by The ‘thermal’ effect is the principle by

which microwave ovens cook food and which microwave ovens cook food and very high RF energy 100mW/cmvery high RF energy 100mW/cm22 or or more can result in heating of biological more can result in heating of biological tissues.tissues.

Tissue damage in humans could occur Tissue damage in humans could occur due to the body’s inability to dissipate due to the body’s inability to dissipate the excessive heat.the excessive heat.

The eye and the testes are particularly The eye and the testes are particularly vulnerable due to relative lack of blood vulnerable due to relative lack of blood flow to dissipate the excessive heat flow to dissipate the excessive heat load.load.

Studies show that environmental Studies show that environmental levels of RF energy are below levels levels of RF energy are below levels necessary to produce a ‘thermal’ necessary to produce a ‘thermal’ effect.effect.

Health Effects from Health Effects from exposure to exposure to

electromagnetic fields cont.electromagnetic fields cont.

Non-Non-Thermal Thermal EffectsEffects

Membrane EffectsMembrane Effects

Signal Transduction EffectsSignal Transduction Effects

Cell proliferative ResponsesCell proliferative Responses

Immune System EffectImmune System Effect

Nervous SystemNervous System

Blood-Brain BarrierBlood-Brain Barrier

Effect on NeurotransmittersEffect on Neurotransmitters

Health Effects from Health Effects from exposure to exposure to

electromagnetic fields cont.electromagnetic fields cont.Other health outcomes investigated Other health outcomes investigated

after RF exposure, include :after RF exposure, include : HeadachesHeadaches General malaiseGeneral malaise Short term memory lossShort term memory loss NauseaNausea Sleep disturbancesSleep disturbances Numbness Numbness

Intrauterine Effects in Intrauterine Effects in Animals Exposed to Animals Exposed to Microwave Fields Microwave Fields

Most of the animal studies have used Most of the animal studies have used higher ELFs than maximum higher ELFs than maximum permissible exposure levels permissible exposure levels according to the IEEE.according to the IEEE.

The most common observation at The most common observation at high exposures was a high exposures was a decrease in decrease in fetal mass.fetal mass.

Lower birthweights, slower growth Lower birthweights, slower growth rates, exencephalies, and other rates, exencephalies, and other skeletal abnormalities were reported skeletal abnormalities were reported in mice.in mice.

Teratogenic effects were only Teratogenic effects were only observed in animals exposed to levels observed in animals exposed to levels of radiation causingof radiation causing a thermal effect. a thermal effect.

Patients and MethodsPatients and Methods

In this study, thirty pregnant women were recruited In this study, thirty pregnant women were recruited from Kasr El Eini Maternity Hospital.from Kasr El Eini Maternity Hospital.

They were subdivided into 2 groups:They were subdivided into 2 groups: Group I: comprised of 15 pregnant women . The Group I: comprised of 15 pregnant women . The

FHR was obtained for 5 minutes with no mobile FHR was obtained for 5 minutes with no mobile phones around. FHR was obtained and traced for phones around. FHR was obtained and traced for another 5 minutes while the patient was on another 5 minutes while the patient was on conversation mode.conversation mode.

Group II: comprised of 15 pregnant women. Doppler Group II: comprised of 15 pregnant women. Doppler ultrasound of the umbilical artery was performed ultrasound of the umbilical artery was performed and the Resistance Index was traced. The patients and the Resistance Index was traced. The patients were instructed to use the cellular phone on were instructed to use the cellular phone on conversation mode for 5 minutes, after which conversation mode for 5 minutes, after which doppler ultrasound of the umbilical artery was doppler ultrasound of the umbilical artery was performed and the Resistance index was traced.performed and the Resistance index was traced.

Inclusion CriteriaInclusion Criteria

No medical disorders or complications of pregnancyNo medical disorders or complications of pregnancy Within age group 18 – 35 years of ageWithin age group 18 – 35 years of age 28-32 weeks gestation28-32 weeks gestation singleton fetus singleton fetus in cephalic presentationin cephalic presentation

QuestionnaireQuestionnaire

A questionnaire was designed and included the A questionnaire was designed and included the following parameters: following parameters:

Personal historyPersonal history Medical historyMedical history Average amount of time spent using Average amount of time spent using

cellular phone cellular phone Symptoms reported from usage Symptoms reported from usage Written consent of approval of participation Written consent of approval of participation

in the researchin the research

ResultsResults

In comparison In comparison between FHR between FHR baseline before baseline before and after exposure and after exposure there was no there was no statistical statistical significant significant difference.difference.

0

20

40

60

80

100

120

140

160beat/min

Before After

ResultsResults

In comparison between FHR In comparison between FHR accelerations before and after accelerations before and after exposure there was no statistical exposure there was no statistical significant difference.significant difference.

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

Before After

ResultsResults

In comparison between R/I of the In comparison between R/I of the umbilical artery before and after umbilical artery before and after exposure there was no statistical exposure there was no statistical significant difference.significant difference.

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

Before After

Discussion: Is It Safe to use Discussion: Is It Safe to use a mobile phone during a mobile phone during

pregnancypregnancy?? The short answer to this question is The short answer to this question is

that mobile phones are probably safe that mobile phones are probably safe to use in pregnancy. Research to use in pregnancy. Research suggests that there is no risk to health suggests that there is no risk to health from mobile phones in the short term .from mobile phones in the short term .

However, it is still a good idea to be However, it is still a good idea to be cautious. Mobile phones have only cautious. Mobile phones have only been in use for a relatively short been in use for a relatively short amount of time, so it's impossible to be amount of time, so it's impossible to be certain of their long-term effects yet. certain of their long-term effects yet.

Discussion: Is It Safe to use Discussion: Is It Safe to use a mobile phone during a mobile phone during

pregnancypregnancy? Cont.? Cont. Mobiles emit low levels of "non-ionizing" Mobiles emit low levels of "non-ionizing"

electromagnetic radiation - as do televisions, electromagnetic radiation - as do televisions, computers, microwave ovens and other man-made computers, microwave ovens and other man-made and natural environmental sources that we're and natural environmental sources that we're exposed to every day. exposed to every day.

Non-ionizing" radiation is much milder than the Non-ionizing" radiation is much milder than the "ionizing" radiation emitted by sources such as x-"ionizing" radiation emitted by sources such as x-rays, radiation therapy machines and CT scans, rays, radiation therapy machines and CT scans, which are known to be harmful to a developing which are known to be harmful to a developing fetus.fetus.

The amniotic fluid surrounding the fetus might be The amniotic fluid surrounding the fetus might be a proposed thermoregulatory barrier mechanism a proposed thermoregulatory barrier mechanism against the thermal effect produced by cellular against the thermal effect produced by cellular phones.phones.

Summary and Summary and ConclusionsConclusions

Our study suggests that there are Our study suggests that there are no risks to fetal well being in the no risks to fetal well being in the short term.short term.

Although reassuring about the Although reassuring about the safety of the technology in the short safety of the technology in the short term, impossible to reach conclusive term, impossible to reach conclusive evidence regarding long term evidence regarding long term cumulative effects.cumulative effects.

RecommendationsRecommendations use your phone as little as possible, and use your phone as little as possible, and

only when you have no alternative - send only when you have no alternative - send a text or use a landline instead.a text or use a landline instead.

keep your calls short !keep your calls short ! try to avoid using your phone if the signal try to avoid using your phone if the signal

strength is low .strength is low . hands-free kit can reduce the SAR for hands-free kit can reduce the SAR for

your head while you're on the phone but your head while you're on the phone but may increase the SAR for the rest of your may increase the SAR for the rest of your body, something you might want to avoid body, something you might want to avoid while you are pregnant. while you are pregnant.

Recommendations cont.Recommendations cont.

Finally, we Finally, we recommend recommend retrospective retrospective randomized control randomized control trials using large trials using large number of number of pregnant women to pregnant women to reach a conclusive reach a conclusive evidence regarding evidence regarding long term residual long term residual effects.effects.