Startseite Effect of electromagnetic field on abortion: A systematic review and meta-analysis
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Effect of electromagnetic field on abortion: A systematic review and meta-analysis

  • Masumeh Ghazanfarpour , Zahra Atarodi Kashani , Reza Pakzad , Fatemeh Abdi ORCID logo EMAIL logo , Fatemeh Alsadat Rahnemaei , Pouran Akhavan Akbari und Nasibeh Roozbeh
Veröffentlicht/Copyright: 3. November 2021
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Aus der Zeitschrift Open Medicine Band 16 Heft 1

Abstract

Background

The increasing use of new technologies by pregnant women inevitably exposes them to the risks of the electromagnetic fields (EMFs). According to the World Health Organization, EMFs are the major sources of pollutants which harm human health. This study was aimed to evaluate the effects of EMF exposure on abortion.

Methods

Web of Science, Cochrane Library, MEDLINE, PubMed, EMBASE, Scopus, and Google Scholar were searched until 2021. Pooled odds ratio (OR) with 95% confidence interval (CI) was estimated using a random-effects model. Heterogeneity was explored using Cochran’s Q test and I 2 index. A meta-regression method was employed to investigate the factors affecting heterogeneity between the studies. The Newcastle-Ottawa scale was used to assess the credibility of the studies.

Results

Eligible studies (N = 17) were analyzed with a total of 57,693 participants. The mean maternal age (95% CI) was 31.06 years (27.32–34.80). Based on meta-analysis results, the pooled estimate for OR of EMF with its effects was 1.27 (95% CI: 1.10–1.46). According to the results of meta-regression, sample size had a significant effect on heterogeneity between studies (p: 0.030), but mother’s age and publication year had no significant effect on heterogeneity (p-value of bothwere >0.05). No publication bias was observed.

Conclusion

Exposure to EMFs above 50 Hz or 16 mG is associated with 1.27× increased risk of abortion. It may be prudent to advise women against this potentially important environmental hazard. Indeed, pregnant women should receive tailored counselling.

Keywords: electromagnetic field; abortion; miscarriage; radiofrequency waves

1 Introduction

Radiofrequency (RF) waves are a type of non-ionizing radiation with short-wavelength radio and electromagnetic waves, which are at the low-energy end of the electromagnetic spectrum. RF waves have lower energy than some other types of non-ionizing radiation, but they have higher energy than extremely low-frequency (ELF) radiation [1]. Ionizing waves include ultraviolet [2] and low frequency electromagnetic waves such as X-rays and gamma rays [3].

When RF radiation is absorbed by the body in large enough amounts, it would produce heat [4]. Humans are exposed to electromagnetic fields (EMFs) produced not only by natural phenomena such as the earth’s magnetic field (MF) or lightning, but also by human activities, such as the use of power lines and electrical appliances [5]. The use of new technology (such as cell phone, Internet, radio, and television] requires integrated telecommunication antenna and thus, the effects and outcomes of the waves produced by them are a hazard to human health. The effects of these radiations on the vulnerable population such as children, the elderly, and pregnant women are different. Cell phone is a major source of electromagnetic waves, and the use of it has grown exponentially within the past few years [6].

EMFs are generally believed to have no relevant non-thermal effects on cells, tissues, and living organisms [7]. According to the World Health Organization (WHO), EMFs are the major sources of pollutants which harm human health [8]. Both pregnant women and fetuses are vulnerable because EMFs are in interaction with cells of embryo’s development. Short-wavelength electromagnetic waves can damage the placental barrier. The membrane prevents the transfer of substances between blood, and this fact indicates that pregnant women should not use cell phone except in case of emergency [9].

Spontaneous abortion is the most common complication of early pregnancy. Pregnancy loss before the 20th week of gestation can be defined as spontaneous abortion, or miscarriage. More than 80% of the miscarriages happen in the first 12 weeks of pregnancy. Approximately two-thirds of early miscarriages are clinically asymptomatic. Fetal, maternal, and paternal factors play an important role in the abortion. Chromosomal abnormality is considered as the most common cause of spontaneous abortion. Environmental, developmental, and medical factors should be considered for maternal abortion. X-ray is one of the factors affecting abortion [10,11].

Some of the reported risk factors for early miscarriage include using a cell phone or computer for more than 6 h a day [12] in addition to living in urban areas in comparison with living in rural areas and the residence within 100 m from mobile phone base stations. The gradual increase in the number of the abortions clinically recognized and the increase in electricity consumption over the past century are not taken into consideration. Increased exposure to each location occurred gradually over time and there was simultaneous improvement in prenatal care [13]. Electric fields in the face of different conductivity cells can significantly generate the heating field and get attenuated. Unlike the external electric fields, the MFs are unperturbed by human body and penetrate without attenuation. The human body is transparent to the MF because there is no magnetic material in the human body. Variable MFs generate electric fields in the human body through a mechanism known as the Faraday Effect [14].

One in four US women will have had an abortion [15]. Long Interspersed LINE-1 Element-1 retrotransposonsor endogenous mutations that can alter gene expression are a major cause of an early abortion in humans [16]. Some of the studies put emphasis on the impact of medium frequency EMF on early pregnancy loss [17]. Spontaneous abortion is reported to be linked with the increased use of electrically heated beds and blankets (which are sources of ELF-MFs) [18]. The non-thermal effects of RF-EMF on the treatment of the human colon cancer cell lines showed that these waves induce ion fluxes which could potentially cause relevant disequilibrium in most ions that may adversely influence the proliferation of cancer cells. Available preclinical and clinical data support the existence of non-thermal membrane/cellular injuries caused by RF-EMF; however, we would need further research [19].

Given that the increasing use of new technologies by pregnant women inevitably exposes them to the risks of the EMF, therefore it is necessary to recognize the unknown adverse effects of these waves for the pregnant women and their fetuses. Pregnant women are exposed to the EMFs for hours during the day during pregnancy. By recognizing the adverse effects of EMF exposure on the pregnant women and their fetuses and informing them, the adverse effects of EMF exposure can be prevented or their potential risks can be reduced. A few studies have investigated the effects of EMF exposure on abortion in pregnant women, and there is no general agreement on the effects of EMF exposure on abortion. On the other hand, the epidemiologic results about the possible adverse effects of low frequency EMF on the fertility are controversial. Therefore, the aim of this systematic review and meta-analysis was to investigate the effects of EMF exposure on abortion.

2 Materials and methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were observed in the report of the study [20]. The protocol of the study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) at the National Institute for Health Research (No: CRD42021234492).

2.1 Search strategy

An updated literature search for studies published until 2021 was conducted in Web of Science, Cochrane Library (Wiley), MEDLINE (Ovid), Pub Med, EMBASE (Ovid), CINAHL (EBSCO), Scopus, Google Scholar, and Clinicaltrial.gov with no restrictions on the language of publication (Table 1).

Table 1

Search Strategy for systematic review

ID Search term
1. “electromagnetic fields”[MeSH Terms] OR “electromagnetic field”[Title/Abstract] OR “magnetic field”[Title/Abstract] OR “electromagnetic wave”[Title/Abstract] OR “EMF”[Title/Abstract] OR “EMW”[Title/Abstract] OR “cell phone”[Title/Abstract] OR “cellphone”[Title/Abstract] OR “car phone”[Title/Abstract] OR “cellular phone”[Title/Abstract] OR “cellular telephone”[Title/Abstract] OR “mobile phone”[Title/Abstract] OR “mobile telephone”[Title/Abstract] OR “Telephone”[Title/Abstract] OR “Mobile”[Title/Abstract] OR “heated water”[Title/Abstract] OR “electric blanket”[Title/Abstract] OR “wire codes”[Title/Abstract] OR “X-rays”[Title/Abstract] OR “computer terminal”[Title/Abstract] OR “video display terminal”[Title/Abstract] OR “VDTs”[Title/Abstract] OR “Microwave”[Title/Abstract] OR “microwaves”[MeSH Terms] OR “radiofrequency”[Title/Abstract] OR “RF”[Title/Abstract] OR “RF-EMFs”[Title/Abstract]
2. “abortion, spontaneous”[MeSH Terms] OR “spontaneous abortion”[Title/Abstract] OR “Abortion”[Title/Abstract] OR “Miscarriage”[Title/Abstract] OR “fetal loss”[Title/Abstract] OR “early pregnancy loss”[Title/Abstract] OR “early pregnancy losses”[Title/Abstract]
3. #1 AND #2

2.2 Inclusion and exclusion criteria

The study’s inclusion criteria were as follows: women with intrauterine pregnancies, singleton pregnancy, and spontaneous conception without the use of the assisted reproductive techniques. Exclusion criteria for the study were as follows: studies with no access to their full texts, correspondences and letters to editor, a history of chronic diseases (diabetes, hypertension, cardiovascular, and liver diseases) [21], genetic disorders, vaginal bleeding, and birth defects in previous pregnancies, and cigarette smoking. Respectively Participants, Exposure, Comparators, Outcomes, Study Design criteria were pregnant women (P), electromagnetic field (E), Control group (C), Abortion (O), Cohort, Case control (S).

2.3 Study selection

The initial search yielded 3,412 results. The eligibility of these studies was independently evaluated by two authors and any disagreements were resolved by consensus. In the first stage, 3,194 studies were excluded due to being irrelevant or duplicated. After reviewing the titles and abstracts of the remaining studies, 188 articles were excluded from the study. In the evaluation of the full texts, 13 out of the remaining 30 articles were excluded due to being ineligible. Finally, a total of 17 eligible articles were reviewed (Figure 1).

Figure 1 PRISMA Flowchart of selected studies.
Figure 1

PRISMA Flowchart of selected studies.

2.4 Quality assessment

Quality of each study was assessed according to the Newcastle-Ottawa scale (NOS). A maximum of ten stars can be given to each study based on the NOS. A maximum of five stars can be given to the selection (such as sample size, non-respondents, and ascertainment of the exposure). A maximum of two stars can be given to the comparability (such as the study control for the most important factor). A maximum of three stars can be given to the outcome (such as outcome of the assessment and statistical test). Studies with a score of nine or ten stars are considered to be of high quality, and studies with a score of seven or eight stars are considered to be of medium quality, and studies scoring less than six stars are considered to be of low quality [22].

2.5 Data extraction

Two authors independently performed the study selection and validity assessment, and resolved any disagreements by consulting a third researcher. Criteria was examined in the study included the first author name, publication year, study design, sample size, region, age, gestational age, electromagnetic field, results, and quality score.

3 Statistical analysis

All the statistical analysis was performed using Stata software version 14.0 (College Station, Texas). For each study, odds ratio (OR) and 95% confidence interval (CI) of miscarriage were extracted. For some studies that reported hazard ratio or risk ratio, based on below formulas, these values were converted to OR:

RR = ( 1 − e HR ⁎ ln ( 1 − r ) ) / r OR = ( ( 1 − p ) ⁎ RR ) / ( 1 − RR ⁎ p ) ,

where RR is the relative risk, HR is the hazard ratio; r is the rate for the reference group, and p is the incidence of the outcome of interest in the non-exposed group (based on baseline data).

Then, pooled OR was calculated by “Metan” command. Heterogeneity was determined using Cochran’s Q test of heterogeneity, and the I 2 index was used to quantify heterogeneity. In accordance with the Higgins classification approach, I 2 values above 0.7 were considered as high heterogeneity. To estimate the pooled OR for miscarriage, the fixed-effect model was used, and when the heterogeneity was greater than 0.7, the random effects model was used. The meta-regression analysis was used to examine the effect of age, sample size, and publication date as factors affecting heterogeneity among studies [23]. The “Metabias” command was used to check for publication bias, and if there was any publication bias, the pooled OR was adjusted with the “Metatrim” command using the trim-and-fill method [24,25]. p-values of 0.05 were regarded as statistically significant.

4 Results

Finally, 17 studies with a total sample size of 57,693 participants included in the study were selected (Table 1). The flowchart of this selection process is shown in Figure 1. Studies examined were published from 1988 to 2018, most of them were done in the USA with 6 (26.1%) studiesand mean maternal age (95% CI) was 31.06 years (27.32–34.80).

5 Pooled estimate of OR

Figure 2 shows the forest plot for OR of abortion in the included studies. The minimum and maximum OR of abortion in China were reported by Zhou et al. was (OR: 0.34; 95% CI: 0.23–0.49) and by Juutilainen et al. was (OR: 5.40; 95% CI: 1.10–28.01), respectively. As shown in Figure 2, the pooled estimate for OR was 1.27 (95% CI: 1.10–1.46) using random effects model approach. This means that in overall, the exposure to EMF was a disfavor for miscarriage so that the odds ratio of miscarriage due to EMF exposure was 1.27× greater than that of control/non-exposed groups.

Figure 2 Forest plot for odds ratio of miscarriage based on random effects model. The midpoint of each line segment shows the odds ratio of miscarriage, the length of the line segment indicates the 95% confidence interval in each study, and the diamond mark illustrates the pooled odds ratio.
Figure 2

Forest plot for odds ratio of miscarriage based on random effects model. The midpoint of each line segment shows the odds ratio of miscarriage, the length of the line segment indicates the 95% confidence interval in each study, and the diamond mark illustrates the pooled odds ratio.

6 Heterogeneity and meta-regression results

According to Cochran’s Q test of heterogeneity, there was a significant heterogeneity among studies (p < 0.001). The heterogeneity amount was 76.7% based on the I 2 index, indicating high heterogeneity. Table 2 presents the results of the univariate meta-regression. There were significant associations between results from studies and sample size (Coefficient: 1 × 104; p-value: 0.030). Mother’s age (Coefficient: 0.051; p-value: 0.537) and publication year (Coefficient: −0.011; p-value: 0.300) had no significant effect on heterogeneity (Table 3 and Figure 3).

Table 2

Overview of all studies included in systematic review

Author (year) Study design Sample size Region Age (year) GA (week) EMF Results QS
Khan et al. (2018) [26] Cohort 4,157 (574) Finland 18.4–39 (27.2) 26.7–42.3 EAS devices No excess risk of miscarriage were observed between cashiers working in grocery stores with and without EAS systems (OR: 0.97; 95% CI: 0.48–1.93) 9
Zhou et al. (2017) [13] CS 32,296 China 16–45 (28.79 ± 2.80) <28 Mobile communication base station, mobile phone, microwave oven, induction cooker, electric blanket, and hair perming and dying appliance There was no excess risk of spontaneous abortion in pregnant women using mobile phone (p = 0.918), microwave oven (p = 0.334), induction cooker (p = 0.55), electric blanket (p = 1), and hair perming and dying appliance (p = 0.539) 8
The residence within 100 m of mobile communication base station was an independent risk factor for spontaneous abortion (p < 0.05) (OR: 0.34; 95% CI: 0.23–0.49)
Li et al. (2017) [27] Cohort 913 California 18≤ <10 EMDEX Lite meter (Enertech Consultants Inc.) for 24 h during pregnancy Women who were exposed to higher MF levels (higher than three quartiles) had 48% greater risk of miscarriage (hazard ratio [HR] = 1.48, 95% CI: 1.03–2.14) than those with lower MF exposure in the lowest quartiles (OR: 1.54; 95% CI: 2.38–1.03) 8
Abad et al. (2016) [28] CS 413 Iran 18–35 (28.2) <12 All wireless services, TV Band I, FM-Radio, mid wave, paging, Band III (DVB-T), trains, Band IV (DVB-T), Band V (DAB), GSM-R, GSM 900, L-Band (DAB), GSM 1800, DECT, UMTS-TDD, UMTS DL, W-LAN, and ISM. An increased risk of miscarriage was observed in women who were exposed to significant levels of electromagnetic wave; however, Wald test did not confirm this finding (OR = 1.12 [0.83–1.52]; p = 0.447) 9
Mahmoudabadi et al. (2015) [29] CC 472 Iran 18–35 <14 Mobile phones A significant association was observed between use of mobile phone during pregnancy and the risk of spontaneous abortion (p < 0.001, OR: 1.11 [1.07–1.16]) 7
Wang et al. (2013) [30] Cohort 450 China 15–44 8 High-voltage power lines and substations (110–500 kV) Miscarriage risk was significantly associated with maximum alley exposure (p = 0.001, OR: 1.78 [1.11–2.82]) 8
Shamsi Mohammadabadi (2013) [31] CC 116 Iran 18–35 <14 EMF in the participants´ houses by an exposure level tester (3D EMF tester/Model: ELF-828; Taiwan) The magnitude of ELF-EMF in the participants´ houses was significantly different between the two groups (miscarriage and normal delivery) (p < 0.001, OR: 1.85 [1.38–2.47]) 8
Zhang et al. (2011) [12] CC 552 China 24–35 9.3 ± 2.8 Computer and cell phone Pregnant women who used computer and cell phone more than 6 h per week were more likely to have abortion (P: 0.05, OR: 1.62 [1.07–2.47]) 8
Fucic et al. (2008) [32] Cohort 112 Republic of Croatia 15–44 <26 X-rays in radiological hospital and radioisotopes in nuclear medicine and biochemical diagnostics hospital At least a three-fold higher rate of spontaneous abortions was found among women exposed to radioisotopes than those exposed to X-ray (OR = 3.68, 95% CI = 1.39–9.74, p < 0.01) 7
Li et al. (2002) [33] Cohort 969 United States <35 <10 Spot measurements were taken in the subject’s bedroom, the kitchen, and the most frequently occupied room that was neither a bedroom nor a kitchen Prenatal maximum MF exposure above a certain level (possibly around 16 mG) may be associated with miscarriage risk (RR: 1.88 [1.2–2.7]) 8
Lee et al. (2002) [34] CC 713 California ≥18 <20 Residential wire codes, very high current configuration, ordinary high current configuration, and ordinary low current configuration The maximum personal MF exposures is associated with the risk of clinical miscarriages and there was a dose response effect with an increase in exposure and with the number of environments (OR: 1.24 [0.70–2.10]) 7
A prospective substudy showed that mothers exposed to EFMs greater than 2 mG had a 3.58 times (0.89–11.75) increased relative risk of miscarriage compared to mothers exposed to EFMs lower than 2 mG
Lee et al. (2000) [35] CC 5,144 California ≥18 ≤13 Electric bed heaters Women who used electric blankets at low settings for most of the night (N = 171) had lower risks of spontaneous abortion than who did not use (OR = 0.81, 0.61–1.21) 7
Grasso (1997) et al. [36] CC 1,656 Italy 15–44 12 Video display units There was no association between video display terminal (VDT) exposure and spontaneous abortion (OR: 1.01 (0.80–1.21)) 7
Juutilainen et al. (1993) [17] CC 191 Finland 29 ± 4.3 ≤12 MF in the living room, in the kitchen, and in the parents’ bedroom Exposure to MF greater than 2.5 mG or 0.2 A/m in the case group had risks 5.44× higher than the controls (OR = 5.44, 1.10–28.0) 7
Ouellet-Hellstrom et al. (1993) [37] CC 3,322 United States 20< <28 Radio and microwave-frequency electromagnetic radiation The OR in physiotherapists exposed to microwave diathermy equipment (20 or more exposures/month) was 1.28. The overall OR was slightly lower after it was controlled for prior fetal loss (OR = 1.26, 95% CI: 1.00–1.59). The risk of miscarriage was not associated with the reported use of shortwave diathermy equipment (OR = 1.07, 95% CI: 0.91–1.24) 7
Lindbohm et al. (1992) [38] CC 585 Finland 20–35 ≤12 VDTS Use of VDTs by pregnant women during the first trimester of pregnancy were not a risk factor for spontaneous abortion (OR: 93; CI: 063–1.38; p = 0.73) 7
Workers who had used VDTs for more than 20 h per week compared to those who used VDTs for less than 20 h per week had a 2.1-fold increased risk for miscarriage (3.70–0.80) and based on the type of device used, workers exposed to EMFs more than 0.4 µT had a 3.8-fold increased risk of miscarriage compared to those exposed to EMFs lower than 0.4 µT (1.10–6.80)
Goldhaber et al. (1988) [39] CC 1,078 California 17< <28 VDTS Exposure over 20 h per week was significantly associated with a relative risk for miscarriage (OR: 1.8; 95% CI: 1.2–2.8) 7

EMF: electromagnetic field; GA: gestational age; QS: quality score; CC: case-control; CS: cross-sectional; OR: odds ratio; CI: confidence interval; EAS: electronic article surveillance; MF: magnetic field.

Figure 3 Association between odds of miscarriage caused by EMF with the sample size (a) and publication year (b) using meta-regression. Size of the circles indicates sample magnitude. There was significant relationship between Ln OR of miscarriage with sample size; but did not change markedly during the study years in this survey.
Figure 3

Association between odds of miscarriage caused by EMF with the sample size (a) and publication year (b) using meta-regression. Size of the circles indicates sample magnitude. There was significant relationship between Ln OR of miscarriage with sample size; but did not change markedly during the study years in this survey.

7 Publication bias

Based on the results of Egger’s test, no significant publication bias was observed for the association between EMF and miscarriage (coefficient: 0.07; p: 0.113), indicating that the result of meta-analysis was robust

Table 3

Result of univariate meta-regression analysis for heterogeneity determinants of ORs of miscarriage

Variables Coefficient 95% CI p-value
Mother’s age (year) 0.051 −0.133 to 0.236 0.537
Publication year (year) −0.011 −0.032 to 0.010 0.300
Sample size (number) −10 × 105 −19 × 105 to 1 × 105 0.030*

*: significance; CI: confidence interval.

8 Discussion

Our results demonstrated that the risk of abortion was increased by 1.27× for pregnant women exposed to ELF and intermediate frequency EMFs in the first trimester of pregnancy. This may be due to living in urban areas, such as living on the outskirts of a city and living near electricity or cell towers, and the long-term use of mobile phones and VDTs.

Because the effects of EMF exposure on pregnant women are different, the WHO has recommended need for more epidemiological studies to investigate the association between exposure to EMF and abortion [30]. There are three sources, such as equipment for medical diagnosis and treatment [37,40], VDTs [36,39,41] and electrical appliances and devices [13,26,29,35], and high voltage power tower near residences, that are producers of EMFs [17,30,33,34], Which are discussed in order. Ionizing radiation is one of the most important waves based on wavelength, and majority of personnel working in the industries and diagnostic and therapeutic departments are exposed to it. Ionizing radiation and certain metals have been known to cause the spontaneous abortions in humans and fetal death in animals [2,42]. In this regard Fucic et al. reported that the occurrence of miscarriages in women exposed to radioisotopes were at least three times more than that in women exposed to X-ray. In addition, chromosome aberrations in peripheral blood lymphocytes were increased in radiation-exposed group compared to the X-ray-exposed group [32]. Waves between 27 and 250 MHz are being used for treatment purposes, because they increase body temperature by 1–2°C by absorbing energy [28]. Physiotherapists experience the exposure to EMFs from shortwave and microwave diathermy devices. This wave can penetrate the adipose tissue and bone and are easily absorbed into the blood and muscle. In fact, the special feature of absorption of RF and MF in the muscle with the aim of improving the blood flow to the deep muscle tissues is the basis of medical diathermy. However, microwaves are selectively absorbed in tissues with high water content such as muscle, blood, and amniotic fluid compared to shortwave radiation. In this regard, the study result showed that use of shortwave diathermy by female physiotherapists was not associated with the risk of miscarriage [43]. However, another study showed that the risk of miscarriage in the group with highest exposure (≥20 exposures/month) to microwave diathermy equipment was increased by 59% [37]. Also, exposure to shortwaves was related to considerably increased OR for congenital malformations and low birth weight [44].

Exposure to MFs non-ionizing radiation is considered as a serious public health challenges. MFs can be produced from older equipment with low frequency MFs (power lines, appliances, and transformers) and from newer sources with higher frequency MFs (wireless networks, cell towers, wireless devices like cell phones, etc.). Cell phone RF waves may result in DNA damage in the fetus [13] and microwave radiation may damage the placental barrier. Results of a study showed that there was an association between cell phone use by mothers and an increased risk of miscarriage, congenital anomalies, and behavioral problems in children [9]. The radiation of mobile phone base stations installed within 100 m of the residence may not have much effect on the general population, but may adversely affect the chromosomal structure of the fetus. An animal study showed that by placing the cell phone in the middle of the incubator for 10–15 days increased the growth restriction of the fetus in exposed group. The pulsed current EMFs may cause DNA damage of the fetus, leading to increased micronucleus rate [45].

The type of EMF in cell phones is both ELF-EMF and RF-EMF. To investigate cell phone effects, the location of the cell phones when not in use, use of hands-free equipment, use of phones for other applications, the specific absorption rate [46] reported by the manufacturer and the average of the effective specific absorption rate (SAR) (average duration of calling time per day × SAR) were measured [31]. The underlying mechanisms of the effects of EMFs on the risk of spontaneous abortions are not well understood. An adverse effect during early fetal development at the cellular level by EMFs of cell phones can conceivably lead to fetal death. Based on the device distance from outside the body to inside the uterus, the exposure of the fetus is likely to be ELF electromagnetic radiation. But perhaps a particular window of frequency, waveform, and intensity of low frequency EMFs can be destructive. In this regard, Shamsi et al. showed that the risk of spontaneous abortion was increased in woman who were exposed to ELF-EMF during pregnancy [31]. However, estimates of the association between cell phone use and the risk of miscarriage did not change significantly despite the adjustment of many known or suspected risk factors. A study conducted on the relationship between the waves generated by a BTS antenna model and spontaneous abortion showed that women exposed to very high-intensity EMFs had an increased risk of miscarriage [28].

Other devices which are commonly used in shops and air terminals are the EAS systems with intermediate frequency (IF) MFs. Accordingly, the results of a study showed that cashiers working in supermarkets with EAS devices at the frequency of 8.2 MHz did not report any increase in the abortion, preterm birth, and low birth weight compared to those working in small supermarkets without such systems. This may be due to the fact that the frequency of EMFs has ELF which is emitted from various electronic devices near the sellers of both stores, and they mainly produce 50 Hz MF, and their share cannot be eliminated. In fact, cashiers working in supermarkets with EAS devices are more exposed to static MFs and intermittent IF MFs, while smaller store cashiers are more exposed to ELF-EMF, so no significant differences on pregnancy outcomes were observed between the two groups [26].

In a study conducted on pregnant women with gestational age less than 10 weeks where their exposure to EMFs were measured by a special monitor, it shows that these women exposed to more than 16 mG of EMFs had 80% increased risk of abortion compared to other pregnant women who were exposed to less than 16 mG of EMF [47]. The theories that empower the possible association between EMF exposure and abortion are as follows: (1) the chemical interaction in cell membrane, (2) reduction in permeability in cell membrane and consequent decrease in cellular connections, (3) increase in free radicals, (4) disorder in mitotic divisions, and (5) damage to cellular proteins and cellular disconnection [48]. The other theory about the association between EMF exposure and abortion is that the depth of penetration of the waves increases in tissues with less water [47].

Another electronic device that is widely used in urban communities is electrically heated beds or ceiling heating systems that produce ELF-EMFs. A prospective study showed that electric blanket use at conception was associated with an increased risk of spontaneous abortion, but heated water bed use was not related to an increased risk of spontaneous abortion at conception. Women living in homes classified as “very high” or “ordinary high” current configuration were not at greater risk [49]. In this regard, the results of another study on fetal loss in families living in homes with or without ceiling cable electric heater showed that the electrically heated beds with 60 Hz EMF exposure may influence human fetal development directly, or through an effect on the mother. In addition, they analyzed the fetal loss during the season. In fact, the difference between user and non-user groups was not examined, but the difference between user groups with the highest exposure compared to those with the least exposure during the month was investigated. There was a significant correlation between the monthly fetal loss rate and the increase in daily temperature in homes with ceiling cable heater, but not in other homes. Using this method, they found that each user group reported fetal loss disproportionately often during the season when EMF exposure was increased [50]. Contrarily, in a cohort study, Lee et al. showed that the rates of spontaneous abortion were lower in women who used electric bed heaters as compared with non-users. Users of electric blankets at low settings for most of the night had lower risks of spontaneous abortion compared to non-users. But for 20 women who used electric blankets at high setting for 1 h or less, the rate was different. The difference in OR in the above two studies may be due to how users use low settings versus high settings and climatic differences in the two studies. The colder the weather, more users use the high settings of the device, thus disconnecting and reconnecting the device. But in the study by Lee et al., most of the electric blanket users kept their blankets at low settings for most of the night, which did not have on or off cycle, resulting in no MF. Therefore, in the study, the use of electric blankets may not reflect exposure to nighttime MFs. Other studies have shown an association between the 60 Hz MF exposure and its effect on immature human beings [51].

VDTs are one of the most widely used devices. Research has shown that the amount of ionizing radiation emitted by VDTs can be detected with equipment for the standard radiology. VDTs generate very low-frequency MFs from the fly back transformers. The results of a case-control study suggested a significantly increased risk of miscarriage for working women in the first trimester of pregnancy who reported using VDTs for more than 20 h/week compared to other working women who reported not using VDTs. One possible explanation for these results is that women who had adverse pregnancy outcomes may have over reported their exposures to VDTs and/or women with normal births may have underreported theirs. The results may also be due to unmeasured factors confounded with high VDT use like poor ergonomic conditions or job-related stress [39]. However, another study measuring the EMFs from VDT showed that the OR for spontaneous abortion in female employees working with VDTs was not increased. However, the OR with adjustment confounder factors (ergonomic factors and mental work load factors) for employees who had used a VDT with a high level of ELF-EMF (>0.9 µT) was increased 3× in comparison with those using a terminal with a low level of these MFs (<0.4 µT) [38]. Schnorr et al. showed that the female telephone operators who used VDTs at work were not associated with an increased risk of spontaneous abortion compared with operators who did not use VDTs. Abdominal exposure to ELF-EMF was similar for both operators who used VDTs and those who did not [52]. It should be noted, that in this study to estimates of exposure, they. measured EMF at one VDT work station and abdominal exposure to ELF-EMF in female telephone operators who used VDTs was lower than above study. One of the weaknesses of the study was recall bias. Concerns have also been expressed by users that VDTs may generate the hazardous electromagnetic radiation, but this study measuring only two models of VDTs showed that the abdominal exposure to ELF-EMF (45–60 Hz) for operators who had used VDTs was similar to the range of exposure to MF in homes. The researchers’ conclusions showing that there is no association between the MF from VDTs and spontaneous abortion are criticized. This may be due to not taking into consideration subclinical abortions and the incorrect definition of exposure (exposure to VDTs was limited to time working with the device, while the highest non-ionizing radiation comes from the back or even the top of the device). Therefore, ELF-EMF measurements at the work stations may provide more information about spontaneous abortion.

Other problems of urban life are suburbanization and residence near high-voltage power towers. To obtain a more accurate estimate of the exposure of pregnant women to EMFs, the following studies have evaluated the exposure to EMFs using different measurement tools. In this regard, the findings of a study showed a strong association between the residential exposure to ELF-MFs (at the intensity of greater than 50 Hz) and fetal loss in early pregnancy with a relative risk of 3–5× in the highest exposure group (over 0.2 or 0.5 µT). The high OR in MFs with a strength of greater than 0.5 A/m or an average residence with a MF strength higher than 0.2 A/m indicates that MF above this value may adversely affect the fetal growth. Retrospective MF measures may lead to degree of misclassification of exposure groups [17]. A nested case-control study was conducted to assess exposure to EMFs. Wire codes, area measures, and three personal meter metrics were assessed. Adjusted OR of the time-weighted average of pregnant women exposed to ELF-EMF was 1.7. For the top three quartile, starting with the highest quartile, 2.3, 1.9, and 1.4 were the maximum values, respectively. In the prospective study, the time-weighted average of pregnant women exposed to ELF-EMF over 2 mG was associated with a three-fold increased relative risk of miscarriage [5]. Juutilainen et al. have reported that indoor exposure above 2.5 mG was associated with a five-fold increase in the miscarriage [17]. Another study showed that a 2.3-fold increase in the relative risk of miscarriage among the siblings in case group, where families live in homes with MFs above 0.2 μT (2 mG), compared to control group, where families live in homes with MFs less than 0.2 μT. It should be noted that EMFs were measured only in 17% of the case group and 34% of the control group. However, with the aggregation of siblings in the case and control groups, the risk of miscarriage was not associated with the measured MF [53]. Another study recruited the pregnant women to wear an ACTi graph accelerometer and EMDEX MF monitor for 7 days and found a positive association between level of activity and likelihood of elevated exposure, most strongly for cut-points of 16 or 20 mG, for both working and nonworking women among whom ORs in the uppermost quartile ranged from 2.1 to 2.6. In fact, peak MF exposure was associated with increased risk of miscarriage [54]. A 2-year cohort study did not find significantly increased risk of miscarriage to be related to the average front-door exposure. However, miscarriage risk was significantly associated with maximum alley exposure. The relative risk of miscarriage was 2.35 [30].

A study was carried out on 149 pregnant women seeking induced abortion of unwanted pregnancies. The women were asked to wear an EMDEX Lite MF meter for a 24 h period to measure MF exposure level. The results showed that embryonic bud length was inversely correlated with maternal daily MF exposure level. Logistic regression showed that women with her 75th percentile of daily MF measurements ≥0.82 mG had a 3.95-fold risk of having a fetus with a shorter embryonic bud length than those whose daily MF exposure were <0.82 mG. MF exposure was correlated with a higher degree of apoptosis. One of the most important strengths of the study is the use of EMDEX Lite, which objectively showed the MF exposure level from various sources [55]. Another study demonstrated that pregnant women who were exposed to higher MF levels had 2.72× the risk of miscarriage than those with lower MF exposure [27], so that the peak MF exposure with risk ratios of 1.8 (with a threshold of approximately 16 mG) as measured by personal monitoring in early pregnancy may be associated with miscarriage risk [32]. These findings are consistent with previous studies examining the association between high MF exposure and miscarriage risk [29,30,46].

8.1 Limitations

Most of the studies were retrospective and few studies were prospective. One of the potential problems of retrospective studies is the recall bias and overexpression of exposure, which affects the accuracy of information. In addition, prospective studies have not been associated with precise control of interfering factors such as chromosomal aberrations, socioeconomic factors, and job stress. Most of the studies conducted on animals have shown an association between abortion and the EMF exposure, while the amount of waves exposed is much higher than the daily exposure of human societies, which cannot be generalized to human studies, and none of the studies has precisely addressed the mechanism of action. It is recommended that prospective studies be conducted with a larger sample size and taking into account the marginalized women of industrial cities with more control over confounding factors and by accurately measuring the daily EMF exposure in mothers.

9 Conclusion

Exposure to EMFs is associated with 1.27× increased risk of abortion. The maximum ELF-MF exposure greater than 50 Hz or 16 mG or even 2–2.5 mG is associated with an increased risk of abortion. Considering the limited evidence base, it may be prudent to advise women against this potentially important environmental hazard. Indeed, pregnant women should receive tailored counseling and stimulate more the much needed research.

Acknowledgements

We appreciate the Hormozgan University of Medical Sciences.

  1. Funding information: This article did not take any funding support.

  2. Author contributions: F.A. conceived the study and approved the final version of the paper. M.G.H. designed the study. R.P. critically analyzed the data. Other authors interpreted the data.

  3. Conflict of interest: Authors have no conflict of interests.

  4. Data availability statement: All the data generated or analyzed during this study are included in this article.

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Received: 2021-04-06
Revised: 2021-10-07
Accepted: 2021-10-19
Published Online: 2021-11-03

© 2021 Masumeh Ghazanfarpour et al., published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  68. Surgical myocardial revascularization outcomes in Kawasaki disease: systematic review and meta-analysis
  69. Decreased chromobox homologue 7 expression is associated with epithelial–mesenchymal transition and poor prognosis in cervical cancer
  70. FGF16 regulated by miR-520b enhances the cell proliferation of lung cancer
  71. Platelet-rich fibrin: Basics of biological actions and protocol modifications
  72. Accurate diagnosis of prostate cancer using logistic regression
  73. miR-377 inhibition enhances the survival of trophoblast cells via upregulation of FNDC5 in gestational diabetes mellitus
  74. Prognostic significance of TRIM28 expression in patients with breast carcinoma
  75. Integrative bioinformatics analysis of KPNA2 in six major human cancers
  76. Exosomal-mediated transfer of OIP5-AS1 enhanced cell chemoresistance to trastuzumab in breast cancer via up-regulating HMGB3 by sponging miR-381-3p
  77. A four-lncRNA signature for predicting prognosis of recurrence patients with gastric cancer
  78. Knockdown of circ_0003204 alleviates oxidative low-density lipoprotein-induced human umbilical vein endothelial cells injury: Circulating RNAs could explain atherosclerosis disease progression
  79. Propofol postpones colorectal cancer development through circ_0026344/miR-645/Akt/mTOR signal pathway
  80. Knockdown of lncRNA TapSAKI alleviates LPS-induced injury in HK-2 cells through the miR-205/IRF3 pathway
  81. COVID-19 severity in relation to sociodemographics and vitamin D use
  82. Clinical analysis of 11 cases of nocardiosis
  83. Cis-regulatory elements in conserved non-coding sequences of nuclear receptor genes indicate for crosstalk between endocrine systems
  84. Four long noncoding RNAs act as biomarkers in lung adenocarcinoma
  85. Real-world evidence of cytomegalovirus reactivation in non-Hodgkin lymphomas treated with bendamustine-containing regimens
  86. Relation between IL-8 level and obstructive sleep apnea syndrome
  87. circAGFG1 sponges miR-28-5p to promote non-small-cell lung cancer progression through modulating HIF-1α level
  88. Nomogram prediction model for renal anaemia in IgA nephropathy patients
  89. Effect of antibiotic use on the efficacy of nivolumab in the treatment of advanced/metastatic non-small cell lung cancer: A meta-analysis
  90. NDRG2 inhibition facilitates angiogenesis of hepatocellular carcinoma
  91. A nomogram for predicting metabolic steatohepatitis: The combination of NAMPT, RALGDS, GADD45B, FOSL2, RTP3, and RASD1
  92. Clinical and prognostic features of MMP-2 and VEGF in AEG patients
  93. The value of miR-510 in the prognosis and development of colon cancer
  94. Functional implications of PABPC1 in the development of ovarian cancer
  95. Prognostic value of preoperative inflammation-based predictors in patients with bladder carcinoma after radical cystectomy
  96. Sublingual immunotherapy increases Treg/Th17 ratio in allergic rhinitis
  97. Prediction of improvement after anterior cruciate ligament reconstruction
  98. Effluent Osteopontin levels reflect the peritoneal solute transport rate
  99. circ_0038467 promotes PM2.5-induced bronchial epithelial cell dysfunction
  100. Significance of miR-141 and miR-340 in cervical squamous cell carcinoma
  101. Association between hair cortisol concentration and metabolic syndrome
  102. Microvessel density as a prognostic indicator of prostate cancer: A systematic review and meta-analysis
  103. Characteristics of BCR–ABL gene variants in patients of chronic myeloid leukemia
  104. Knee alterations in rheumatoid arthritis: Comparison of US and MRI
  105. Long non-coding RNA TUG1 aggravates cerebral ischemia and reperfusion injury by sponging miR-493-3p/miR-410-3p
  106. lncRNA MALAT1 regulated ATAD2 to facilitate retinoblastoma progression via miR-655-3p
  107. Development and validation of a nomogram for predicting severity in patients with hemorrhagic fever with renal syndrome: A retrospective study
  108. Analysis of COVID-19 outbreak origin in China in 2019 using differentiation method for unusual epidemiological events
  109. Laparoscopic versus open major liver resection for hepatocellular carcinoma: A case-matched analysis of short- and long-term outcomes
  110. Travelers’ vaccines and their adverse events in Nara, Japan
  111. Association between Tfh and PGA in children with Henoch–Schönlein purpura
  112. Can exchange transfusion be replaced by double-LED phototherapy?
  113. circ_0005962 functions as an oncogene to aggravate NSCLC progression
  114. Circular RNA VANGL1 knockdown suppressed viability, promoted apoptosis, and increased doxorubicin sensitivity through targeting miR-145-5p to regulate SOX4 in bladder cancer cells
  115. Serum intact fibroblast growth factor 23 in healthy paediatric population
  116. Algorithm of rational approach to reconstruction in Fournier’s disease
  117. A meta-analysis of exosome in the treatment of spinal cord injury
  118. Src-1 and SP2 promote the proliferation and epithelial–mesenchymal transition of nasopharyngeal carcinoma
  119. Dexmedetomidine may decrease the bupivacaine toxicity to heart
  120. Hypoxia stimulates the migration and invasion of osteosarcoma via up-regulating the NUSAP1 expression
  121. Long noncoding RNA XIST knockdown relieves the injury of microglia cells after spinal cord injury by sponging miR-219-5p
  122. External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients
  123. miR-128-3p reduced acute lung injury induced by sepsis via targeting PEL12
  124. HAGLR promotes neuron differentiation through the miR-130a-3p-MeCP2 axis
  125. Phosphoglycerate mutase 2 is elevated in serum of patients with heart failure and correlates with the disease severity and patient’s prognosis
  126. Cell population data in identifying active tuberculosis and community-acquired pneumonia
  127. Prognostic value of microRNA-4521 in non-small cell lung cancer and its regulatory effect on tumor progression
  128. Mean platelet volume and red blood cell distribution width is associated with prognosis in premature neonates with sepsis
  129. 3D-printed porous scaffold promotes osteogenic differentiation of hADMSCs
  130. Association of gene polymorphisms with women urinary incontinence
  131. Influence of COVID-19 pandemic on stress levels of urologic patients
  132. miR-496 inhibits proliferation via LYN and AKT pathway in gastric cancer
  133. miR-519d downregulates LEP expression to inhibit preeclampsia development
  134. Comparison of single- and triple-port VATS for lung cancer: A meta-analysis
  135. Fluorescent light energy modulates healing in skin grafted mouse model
  136. Silencing CDK6-AS1 inhibits LPS-induced inflammatory damage in HK-2 cells
  137. Predictive effect of DCE-MRI and DWI in brain metastases from NSCLC
  138. Severe postoperative hyperbilirubinemia in congenital heart disease
  139. Baicalin improves podocyte injury in rats with diabetic nephropathy by inhibiting PI3K/Akt/mTOR signaling pathway
  140. Clinical factors predicting ureteral stent failure in patients with external ureteral compression
  141. Novel H2S donor proglumide-ADT-OH protects HUVECs from ox-LDL-induced injury through NF-κB and JAK/SATA pathway
  142. Triple-Endobutton and clavicular hook: A propensity score matching analysis
  143. Long noncoding RNA MIAT inhibits the progression of diabetic nephropathy and the activation of NF-κB pathway in high glucose-treated renal tubular epithelial cells by the miR-182-5p/GPRC5A axis
  144. Serum exosomal miR-122-5p, GAS, and PGR in the non-invasive diagnosis of CAG
  145. miR-513b-5p inhibits the proliferation and promotes apoptosis of retinoblastoma cells by targeting TRIB1
  146. Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p
  147. The diagnostic and prognostic value of miR-92a in gastric cancer: A systematic review and meta-analysis
  148. Prognostic value of α2δ1 in hypopharyngeal carcinoma: A retrospective study
  149. No significant benefit of moderate-dose vitamin C on severe COVID-19 cases
  150. circ_0000467 promotes the proliferation, metastasis, and angiogenesis in colorectal cancer cells through regulating KLF12 expression by sponging miR-4766-5p
  151. Downregulation of RAB7 and Caveolin-1 increases MMP-2 activity in renal tubular epithelial cells under hypoxic conditions
  152. Educational program for orthopedic surgeons’ influences for osteoporosis
  153. Expression and function analysis of CRABP2 and FABP5, and their ratio in esophageal squamous cell carcinoma
  154. GJA1 promotes hepatocellular carcinoma progression by mediating TGF-β-induced activation and the epithelial–mesenchymal transition of hepatic stellate cells
  155. lncRNA-ZFAS1 promotes the progression of endometrial carcinoma by targeting miR-34b to regulate VEGFA expression
  156. Anticoagulation is the answer in treating noncritical COVID-19 patients
  157. Effect of late-onset hemorrhagic cystitis on PFS after haplo-PBSCT
  158. Comparison of Dako HercepTest and Ventana PATHWAY anti-HER2 (4B5) tests and their correlation with silver in situ hybridization in lung adenocarcinoma
  159. VSTM1 regulates monocyte/macrophage function via the NF-κB signaling pathway
  160. Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis
  161. Treatment of osteoporosis with teriparatide: The Slovenian experience
  162. New targets of morphine postconditioning protection of the myocardium in ischemia/reperfusion injury: Involvement of HSP90/Akt and C5a/NF-κB
  163. Superenhancer–transcription factor regulatory network in malignant tumors
  164. β-Cell function is associated with osteosarcopenia in middle-aged and older nonobese patients with type 2 diabetes: A cross-sectional study
  165. Clinical features of atypical tuberculosis mimicking bacterial pneumonia
  166. Proteoglycan-depleted regions of annular injury promote nerve ingrowth in a rabbit disc degeneration model
  167. Effect of electromagnetic field on abortion: A systematic review and meta-analysis
  168. miR-150-5p affects AS plaque with ASMC proliferation and migration by STAT1
  169. MALAT1 promotes malignant pleural mesothelioma by sponging miR-141-3p
  170. Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model
  171. miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway
  172. Identification of LIG1 and LIG3 as prognostic biomarkers in breast cancer
  173. MitoQ inhibits hepatic stellate cell activation and liver fibrosis by enhancing PINK1/parkin-mediated mitophagy
  174. Dissecting role of founder mutation p.V727M in GNE in Indian HIBM cohort
  175. circATP2A2 promotes osteosarcoma progression by upregulating MYH9
  176. Prognostic role of oxytocin receptor in colon adenocarcinoma
  177. Review Articles
  178. The function of non-coding RNAs in idiopathic pulmonary fibrosis
  179. Efficacy and safety of therapeutic plasma exchange in stiff person syndrome
  180. Role of cesarean section in the development of neonatal gut microbiota: A systematic review
  181. Small cell lung cancer transformation during antitumor therapies: A systematic review
  182. Research progress of gut microbiota and frailty syndrome
  183. Recommendations for outpatient activity in COVID-19 pandemic
  184. Rapid Communication
  185. Disparity in clinical characteristics between 2019 novel coronavirus pneumonia and leptospirosis
  186. Use of microspheres in embolization for unruptured renal angiomyolipomas
  187. COVID-19 cases with delayed absorption of lung lesion
  188. A triple combination of treatments on moderate COVID-19
  189. Social networks and eating disorders during the Covid-19 pandemic
  190. Letter
  191. COVID-19, WHO guidelines, pedagogy, and respite
  192. Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
  193. COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
  194. What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
  195. Case Report
  196. Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
  197. CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
  198. Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
  199. Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
  200. Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
  201. Pulmonary parenchymal involvement caused by Tropheryma whipplei
  202. Mediastinal mixed germ cell tumor: A case report and literature review
  203. Ovarian female adnexal tumor of probable Wolffian origin – Case report
  204. Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report
  205. Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review
  206. Primary orbital ganglioneuroblastoma: A case report
  207. Primary aortic intimal sarcoma masquerading as intramural hematoma
  208. Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review
  209. Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature
  210. Chondroblastoma of mandibular condyle: Case report and literature review
  211. Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report
  212. Primary intradural extramedullary extraosseous Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (PIEES/PNET) of the thoracolumbar spine: A case report and literature review
  213. Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report
  214. High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
  215. Rapid response of locally advanced oral squamous cell carcinoma to apatinib: A case report
  216. Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review
  217. Usage of intermingled skin allografts and autografts in a senior patient with major burn injury
  218. Retraction
  219. Retraction on “Dihydromyricetin attenuates inflammation through TLR4/NF-kappa B pathway”
  220. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part I
  221. An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers
  222. Breast cancer recurrence prediction with ensemble methods and cost-sensitive learning
https://doi.org/10.1515/med-2021-0384
Schlagwörter für diesen Artikel
electromagnetic field; abortion; miscarriage; radiofrequency waves
Creative Commons
BY 4.0

Artikel in diesem Heft

  1. Research Articles
  2. Identification of ZG16B as a prognostic biomarker in breast cancer
  3. Behçet’s disease with latent Mycobacterium tuberculosis infection
  4. Erratum
  5. Erratum to “Suffering from Cerebral Small Vessel Disease with and without Metabolic Syndrome”
  6. Research Articles
  7. GPR37 promotes the malignancy of lung adenocarcinoma via TGF-β/Smad pathway
  8. Expression and role of ABIN1 in sepsis: In vitro and in vivo studies
  9. Additional baricitinib loading dose improves clinical outcome in COVID-19
  10. The co-treatment of rosuvastatin with dapagliflozin synergistically inhibited apoptosis via activating the PI3K/AKt/mTOR signaling pathway in myocardial ischemia/reperfusion injury rats
  11. SLC12A8 plays a key role in bladder cancer progression and EMT
  12. LncRNA ATXN8OS enhances tamoxifen resistance in breast cancer
  13. Case Report
  14. Serratia marcescens as a cause of unfavorable outcome in the twin pregnancy
  15. Spleno-adrenal fusion mimicking an adrenal metastasis of a renal cell carcinoma: A case report and embryological background
  16. Research Articles
  17. TRIM25 contributes to the malignancy of acute myeloid leukemia and is negatively regulated by microRNA-137
  18. CircRNA circ_0004370 promotes cell proliferation, migration, and invasion and inhibits cell apoptosis of esophageal cancer via miR-1301-3p/COL1A1 axis
  19. LncRNA XIST regulates atherosclerosis progression in ox-LDL-induced HUVECs
  20. Potential role of IFN-γ and IL-5 in sepsis prediction of preterm neonates
  21. Rapid Communication
  22. COVID-19 vaccine: Call for employees in international transportation industries and international travelers as the first priority in global distribution
  23. Case Report
  24. Rare squamous cell carcinoma of the kidney with concurrent xanthogranulomatous pyelonephritis: A case report and review of the literature
  25. An infertile female delivered a baby after removal of primary renal carcinoid tumor
  26. Research Articles
  27. Hypertension, BMI, and cardiovascular and cerebrovascular diseases
  28. Case Report
  29. Coexistence of bilateral macular edema and pale optic disc in the patient with Cohen syndrome
  30. Research Articles
  31. Correlation between kinematic sagittal parameters of the cervical lordosis or head posture and disc degeneration in patients with posterior neck pain
  32. Review Articles
  33. Hepatoid adenocarcinoma of the lung: An analysis of the Surveillance, Epidemiology, and End Results (SEER) database
  34. Research Articles
  35. Thermography in the diagnosis of carpal tunnel syndrome
  36. Pemetrexed-based first-line chemotherapy had particularly prominent objective response rate for advanced NSCLC: A network meta-analysis
  37. Comparison of single and double autologous stem cell transplantation in multiple myeloma patients
  38. The influence of smoking in minimally invasive spinal fusion surgery
  39. Impact of body mass index on left atrial dimension in HOCM patients
  40. Expression and clinical significance of CMTM1 in hepatocellular carcinoma
  41. miR-142-5p promotes cervical cancer progression by targeting LMX1A through Wnt/β-catenin pathway
  42. Comparison of multiple flatfoot indicators in 5–8-year-old children
  43. Early MRI imaging and follow-up study in cerebral amyloid angiopathy
  44. Intestinal fatty acid-binding protein as a biomarker for the diagnosis of strangulated intestinal obstruction: A meta-analysis
  45. miR-128-3p inhibits apoptosis and inflammation in LPS-induced sepsis by targeting TGFBR2
  46. Dynamic perfusion CT – A promising tool to diagnose pancreatic ductal adenocarcinoma
  47. Biomechanical evaluation of self-cinching stitch techniques in rotator cuff repair: The single-loop and double-loop knot stitches
  48. Review Articles
  49. The ambiguous role of mannose-binding lectin (MBL) in human immunity
  50. Case Report
  51. Membranous nephropathy with pulmonary cryptococcosis with improved 1-year follow-up results: A case report
  52. Fertility problems in males carrying an inversion of chromosome 10
  53. Acute myeloid leukemia with leukemic pleural effusion and high levels of pleural adenosine deaminase: A case report and review of literature
  54. Metastatic renal Ewing’s sarcoma in adult woman: Case report and review of the literature
  55. Burkitt-like lymphoma with 11q aberration in a patient with AIDS and a patient without AIDS: Two cases reports and literature review
  56. Skull hemophilia pseudotumor: A case report
  57. Judicious use of low-dosage corticosteroids for non-severe COVID-19: A case report
  58. Adult-onset citrullinaemia type II with liver cirrhosis: A rare cause of hyperammonaemia
  59. Clinicopathologic features of Good’s syndrome: Two cases and literature review
  60. Fatal immune-related hepatitis with intrahepatic cholestasis and pneumonia associated with camrelizumab: A case report and literature review
  61. Research Articles
  62. Effects of hydroxyethyl starch and gelatin on the risk of acute kidney injury following orthotopic liver transplantation: A multicenter retrospective comparative clinical study
  63. Significance of nucleic acid positive anal swab in COVID-19 patients
  64. circAPLP2 promotes colorectal cancer progression by upregulating HELLS by targeting miR-335-5p
  65. Ratios between circulating myeloid cells and lymphocytes are associated with mortality in severe COVID-19 patients
  66. Risk factors of left atrial appendage thrombus in patients with non-valvular atrial fibrillation
  67. Clinical features of hypertensive patients with COVID-19 compared with a normotensive group: Single-center experience in China
  68. Surgical myocardial revascularization outcomes in Kawasaki disease: systematic review and meta-analysis
  69. Decreased chromobox homologue 7 expression is associated with epithelial–mesenchymal transition and poor prognosis in cervical cancer
  70. FGF16 regulated by miR-520b enhances the cell proliferation of lung cancer
  71. Platelet-rich fibrin: Basics of biological actions and protocol modifications
  72. Accurate diagnosis of prostate cancer using logistic regression
  73. miR-377 inhibition enhances the survival of trophoblast cells via upregulation of FNDC5 in gestational diabetes mellitus
  74. Prognostic significance of TRIM28 expression in patients with breast carcinoma
  75. Integrative bioinformatics analysis of KPNA2 in six major human cancers
  76. Exosomal-mediated transfer of OIP5-AS1 enhanced cell chemoresistance to trastuzumab in breast cancer via up-regulating HMGB3 by sponging miR-381-3p
  77. A four-lncRNA signature for predicting prognosis of recurrence patients with gastric cancer
  78. Knockdown of circ_0003204 alleviates oxidative low-density lipoprotein-induced human umbilical vein endothelial cells injury: Circulating RNAs could explain atherosclerosis disease progression
  79. Propofol postpones colorectal cancer development through circ_0026344/miR-645/Akt/mTOR signal pathway
  80. Knockdown of lncRNA TapSAKI alleviates LPS-induced injury in HK-2 cells through the miR-205/IRF3 pathway
  81. COVID-19 severity in relation to sociodemographics and vitamin D use
  82. Clinical analysis of 11 cases of nocardiosis
  83. Cis-regulatory elements in conserved non-coding sequences of nuclear receptor genes indicate for crosstalk between endocrine systems
  84. Four long noncoding RNAs act as biomarkers in lung adenocarcinoma
  85. Real-world evidence of cytomegalovirus reactivation in non-Hodgkin lymphomas treated with bendamustine-containing regimens
  86. Relation between IL-8 level and obstructive sleep apnea syndrome
  87. circAGFG1 sponges miR-28-5p to promote non-small-cell lung cancer progression through modulating HIF-1α level
  88. Nomogram prediction model for renal anaemia in IgA nephropathy patients
  89. Effect of antibiotic use on the efficacy of nivolumab in the treatment of advanced/metastatic non-small cell lung cancer: A meta-analysis
  90. NDRG2 inhibition facilitates angiogenesis of hepatocellular carcinoma
  91. A nomogram for predicting metabolic steatohepatitis: The combination of NAMPT, RALGDS, GADD45B, FOSL2, RTP3, and RASD1
  92. Clinical and prognostic features of MMP-2 and VEGF in AEG patients
  93. The value of miR-510 in the prognosis and development of colon cancer
  94. Functional implications of PABPC1 in the development of ovarian cancer
  95. Prognostic value of preoperative inflammation-based predictors in patients with bladder carcinoma after radical cystectomy
  96. Sublingual immunotherapy increases Treg/Th17 ratio in allergic rhinitis
  97. Prediction of improvement after anterior cruciate ligament reconstruction
  98. Effluent Osteopontin levels reflect the peritoneal solute transport rate
  99. circ_0038467 promotes PM2.5-induced bronchial epithelial cell dysfunction
  100. Significance of miR-141 and miR-340 in cervical squamous cell carcinoma
  101. Association between hair cortisol concentration and metabolic syndrome
  102. Microvessel density as a prognostic indicator of prostate cancer: A systematic review and meta-analysis
  103. Characteristics of BCR–ABL gene variants in patients of chronic myeloid leukemia
  104. Knee alterations in rheumatoid arthritis: Comparison of US and MRI
  105. Long non-coding RNA TUG1 aggravates cerebral ischemia and reperfusion injury by sponging miR-493-3p/miR-410-3p
  106. lncRNA MALAT1 regulated ATAD2 to facilitate retinoblastoma progression via miR-655-3p
  107. Development and validation of a nomogram for predicting severity in patients with hemorrhagic fever with renal syndrome: A retrospective study
  108. Analysis of COVID-19 outbreak origin in China in 2019 using differentiation method for unusual epidemiological events
  109. Laparoscopic versus open major liver resection for hepatocellular carcinoma: A case-matched analysis of short- and long-term outcomes
  110. Travelers’ vaccines and their adverse events in Nara, Japan
  111. Association between Tfh and PGA in children with Henoch–Schönlein purpura
  112. Can exchange transfusion be replaced by double-LED phototherapy?
  113. circ_0005962 functions as an oncogene to aggravate NSCLC progression
  114. Circular RNA VANGL1 knockdown suppressed viability, promoted apoptosis, and increased doxorubicin sensitivity through targeting miR-145-5p to regulate SOX4 in bladder cancer cells
  115. Serum intact fibroblast growth factor 23 in healthy paediatric population
  116. Algorithm of rational approach to reconstruction in Fournier’s disease
  117. A meta-analysis of exosome in the treatment of spinal cord injury
  118. Src-1 and SP2 promote the proliferation and epithelial–mesenchymal transition of nasopharyngeal carcinoma
  119. Dexmedetomidine may decrease the bupivacaine toxicity to heart
  120. Hypoxia stimulates the migration and invasion of osteosarcoma via up-regulating the NUSAP1 expression
  121. Long noncoding RNA XIST knockdown relieves the injury of microglia cells after spinal cord injury by sponging miR-219-5p
  122. External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients
  123. miR-128-3p reduced acute lung injury induced by sepsis via targeting PEL12
  124. HAGLR promotes neuron differentiation through the miR-130a-3p-MeCP2 axis
  125. Phosphoglycerate mutase 2 is elevated in serum of patients with heart failure and correlates with the disease severity and patient’s prognosis
  126. Cell population data in identifying active tuberculosis and community-acquired pneumonia
  127. Prognostic value of microRNA-4521 in non-small cell lung cancer and its regulatory effect on tumor progression
  128. Mean platelet volume and red blood cell distribution width is associated with prognosis in premature neonates with sepsis
  129. 3D-printed porous scaffold promotes osteogenic differentiation of hADMSCs
  130. Association of gene polymorphisms with women urinary incontinence
  131. Influence of COVID-19 pandemic on stress levels of urologic patients
  132. miR-496 inhibits proliferation via LYN and AKT pathway in gastric cancer
  133. miR-519d downregulates LEP expression to inhibit preeclampsia development
  134. Comparison of single- and triple-port VATS for lung cancer: A meta-analysis
  135. Fluorescent light energy modulates healing in skin grafted mouse model
  136. Silencing CDK6-AS1 inhibits LPS-induced inflammatory damage in HK-2 cells
  137. Predictive effect of DCE-MRI and DWI in brain metastases from NSCLC
  138. Severe postoperative hyperbilirubinemia in congenital heart disease
  139. Baicalin improves podocyte injury in rats with diabetic nephropathy by inhibiting PI3K/Akt/mTOR signaling pathway
  140. Clinical factors predicting ureteral stent failure in patients with external ureteral compression
  141. Novel H2S donor proglumide-ADT-OH protects HUVECs from ox-LDL-induced injury through NF-κB and JAK/SATA pathway
  142. Triple-Endobutton and clavicular hook: A propensity score matching analysis
  143. Long noncoding RNA MIAT inhibits the progression of diabetic nephropathy and the activation of NF-κB pathway in high glucose-treated renal tubular epithelial cells by the miR-182-5p/GPRC5A axis
  144. Serum exosomal miR-122-5p, GAS, and PGR in the non-invasive diagnosis of CAG
  145. miR-513b-5p inhibits the proliferation and promotes apoptosis of retinoblastoma cells by targeting TRIB1
  146. Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p
  147. The diagnostic and prognostic value of miR-92a in gastric cancer: A systematic review and meta-analysis
  148. Prognostic value of α2δ1 in hypopharyngeal carcinoma: A retrospective study
  149. No significant benefit of moderate-dose vitamin C on severe COVID-19 cases
  150. circ_0000467 promotes the proliferation, metastasis, and angiogenesis in colorectal cancer cells through regulating KLF12 expression by sponging miR-4766-5p
  151. Downregulation of RAB7 and Caveolin-1 increases MMP-2 activity in renal tubular epithelial cells under hypoxic conditions
  152. Educational program for orthopedic surgeons’ influences for osteoporosis
  153. Expression and function analysis of CRABP2 and FABP5, and their ratio in esophageal squamous cell carcinoma
  154. GJA1 promotes hepatocellular carcinoma progression by mediating TGF-β-induced activation and the epithelial–mesenchymal transition of hepatic stellate cells
  155. lncRNA-ZFAS1 promotes the progression of endometrial carcinoma by targeting miR-34b to regulate VEGFA expression
  156. Anticoagulation is the answer in treating noncritical COVID-19 patients
  157. Effect of late-onset hemorrhagic cystitis on PFS after haplo-PBSCT
  158. Comparison of Dako HercepTest and Ventana PATHWAY anti-HER2 (4B5) tests and their correlation with silver in situ hybridization in lung adenocarcinoma
  159. VSTM1 regulates monocyte/macrophage function via the NF-κB signaling pathway
  160. Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis
  161. Treatment of osteoporosis with teriparatide: The Slovenian experience
  162. New targets of morphine postconditioning protection of the myocardium in ischemia/reperfusion injury: Involvement of HSP90/Akt and C5a/NF-κB
  163. Superenhancer–transcription factor regulatory network in malignant tumors
  164. β-Cell function is associated with osteosarcopenia in middle-aged and older nonobese patients with type 2 diabetes: A cross-sectional study
  165. Clinical features of atypical tuberculosis mimicking bacterial pneumonia
  166. Proteoglycan-depleted regions of annular injury promote nerve ingrowth in a rabbit disc degeneration model
  167. Effect of electromagnetic field on abortion: A systematic review and meta-analysis
  168. miR-150-5p affects AS plaque with ASMC proliferation and migration by STAT1
  169. MALAT1 promotes malignant pleural mesothelioma by sponging miR-141-3p
  170. Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model
  171. miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway
  172. Identification of LIG1 and LIG3 as prognostic biomarkers in breast cancer
  173. MitoQ inhibits hepatic stellate cell activation and liver fibrosis by enhancing PINK1/parkin-mediated mitophagy
  174. Dissecting role of founder mutation p.V727M in GNE in Indian HIBM cohort
  175. circATP2A2 promotes osteosarcoma progression by upregulating MYH9
  176. Prognostic role of oxytocin receptor in colon adenocarcinoma
  177. Review Articles
  178. The function of non-coding RNAs in idiopathic pulmonary fibrosis
  179. Efficacy and safety of therapeutic plasma exchange in stiff person syndrome
  180. Role of cesarean section in the development of neonatal gut microbiota: A systematic review
  181. Small cell lung cancer transformation during antitumor therapies: A systematic review
  182. Research progress of gut microbiota and frailty syndrome
  183. Recommendations for outpatient activity in COVID-19 pandemic
  184. Rapid Communication
  185. Disparity in clinical characteristics between 2019 novel coronavirus pneumonia and leptospirosis
  186. Use of microspheres in embolization for unruptured renal angiomyolipomas
  187. COVID-19 cases with delayed absorption of lung lesion
  188. A triple combination of treatments on moderate COVID-19
  189. Social networks and eating disorders during the Covid-19 pandemic
  190. Letter
  191. COVID-19, WHO guidelines, pedagogy, and respite
  192. Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
  193. COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
  194. What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
  195. Case Report
  196. Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
  197. CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
  198. Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
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Heruntergeladen am 8.11.2025 von https://www.degruyterbrill.com/document/doi/10.1515/med-2021-0384/html?lang=de
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