1. Effect of electromagnetic waves of cellular phones on fetal blood flow and heart rate patterns: a pilot study Thesis presented by Amr Hazim Abbassy M.B, B.Ch Supervised by Prof. Dr. Ismaeel Foad Al-Aseily Assistant Professor Dr. Osama Mahmoud Azmy Assistant Prof Dr.Foad Abdelqader Abohemela

2. Question: “Doctor, is it safe to use the mobile phone during pregnancy?”

3. Scientific Background Scientific Background Increased use of cellular phones during pregnancy while little is known about their hazards. Increased use of cellular phones during pregnancy while little is known about their hazards. Proximity of the fetus to cell phone during transport and use. Proximity of the fetus to cell phone during transport and use.  Studies indicate that there might be health hazards at non-thermal levels as well as behavioral disorders in the offspring.

4. Scientific Background continued Cellular phones emit microwave radiation in the spectrum region of 800-900 MHz Cellular phones emit microwave radiation in the spectrum region of 800-900 MHz The rate at which radiation is absorbed is measured by the Specific Absorption Rate (SAR). The rate at which radiation is absorbed is measured by the Specific Absorption Rate (SAR). Currently, it is difficult to measure the amount ELF absorbed by the fetus due to cellular phone use. Currently, it is difficult to measure the amount ELF absorbed by the fetus due to cellular phone use.

5. Aim of the work  To assess the effect of cellular phones on pregnancy.  To provide guidelines and safety measures for using the technology during pregnancy.  To provide an addition to the growing research done worldwide on the possible health hazards of this relatively new technology.

6. The Fetal Heart Rate Electronic fetal heart rate monitoring is commonly used to assess fetal well-being Electronic fetal heart rate monitoring is commonly used to assess fetal well-being The fetal heart rate undergoes constant and minute adjustments in response to the fetal environment and stimuli. The fetal heart rate undergoes constant and minute adjustments in response to the fetal environment and stimuli. The FHR is controlled by the autonomic nervous system. The inhibitory influence on the heart rate is conveyed by the vagus nerve, whereas excitatory influence is conveyed by the sympathetic nervous system. The FHR is controlled by the autonomic nervous system. The inhibitory influence on the heart rate is conveyed by the vagus nerve, whereas excitatory influence is conveyed by the sympathetic nervous system.

7. The Fetal Heart Rate continued The normal FHR range is between 120 and 160 beats per minute (bpm). The normal FHR range is between 120 and 160 beats per minute (bpm). Fetal heart rate patterns are classified as reassuring, nonreassuring or ominous. Fetal heart rate patterns are classified as reassuring, nonreassuring or ominous. Reassuring patterns correlate well with a good fetal outcome, while nonreassuring patterns do not. Reassuring patterns correlate well with a good fetal outcome, while nonreassuring patterns do not.

8. Doppler Ultrasound Doppler US offers a unique noninvasive technology for investigating the circulatory system. Doppler US offers a unique noninvasive technology for investigating the circulatory system. Doppler US velocimetry has been extensively used to investigate fetal, fetoplacental, and uteroplacental circulations. Doppler US velocimetry has been extensively used to investigate fetal, fetoplacental, and uteroplacental circulations. There is ample evidence associating abnormal Doppler findings with complications of pregnancy and an adverse perinatal outcome as in multiple gestations, fetal anemia, fetal IUGR, and fetal congenital heart diseases. There is ample evidence associating abnormal Doppler findings with complications of pregnancy and an adverse perinatal outcome as in multiple gestations, fetal anemia, fetal IUGR, and fetal congenital heart diseases.

9. The Body is an Electrical Organism Heartbeat Heartbeat Brainwaves Brainwaves Cell Division Cell Division

10. Health Effects from exposure to electromagnetic fields Expanding use of cellular technology has led to some speculations that ‘electromagnetic pollution’ is causing significant risks to human health. Expanding use of cellular technology has led to some speculations that ‘electromagnetic pollution’ is causing significant risks to human health. The amount of energy absorbed by the body is called the ‘Specific Absorption Rate’ expressed in (W/Kg). The amount of energy absorbed by the body is called the ‘Specific Absorption Rate’ expressed in (W/Kg). Biological effects that result from heating of tissues by RF energy are referred to as “thermal” effects. Biological effects that result from heating of tissues by RF energy are referred to as “thermal” effects. However studies indicate that biological effects may be caused without heating of tissues referred to as “non-thermal effect” However studies indicate that biological effects may be caused without heating of tissues referred to as “non-thermal effect”

11. Health Effects from exposure to electromagnetic fields cont. The ‘thermal’ effect is the principle by which microwave ovens cook food and very high RF energy 100mW/cm 2 or more can result in heating of biological tissues. The ‘thermal’ effect is the principle by which microwave ovens cook food and very high RF energy 100mW/cm 2 or more can result in heating of biological tissues. Tissue damage in humans could occur due to the body’s inability to dissipate the excessive heat. Tissue damage in humans could occur due to the body’s inability to dissipate the excessive heat. The eye and the testes are particularly vulnerable due to relative lack of blood flow to dissipate the excessive heat load. The eye and the testes are particularly vulnerable due to relative lack of blood flow to dissipate the excessive heat load. Studies show that environmental levels of RF energy are below levels necessary to produce a ‘thermal’ effect. Studies show that environmental levels of RF energy are below levels necessary to produce a ‘thermal’ effect.

12. Health Effects from exposure to electromagnetic fields cont. Non-Thermal Effects Membrane Effects Signal Transduction Effects Cell proliferative Responses Immune System Effect Nervous System Blood-Brain Barrier Effect on Neurotransmitters

13. Health Effects from exposure to electromagnetic fields cont. Other health outcomes investigated after RF exposure, include : Headaches Headaches General malaise General malaise Short term memory loss Short term memory loss Nausea Nausea Sleep disturbances Sleep disturbances Numbness Numbness

14. Intrauterine Effects in Animals Exposed to Microwave Fields Most of the animal studies have used higher ELFs than maximum permissible exposure levels according to the IEEE. Most of the animal studies have used higher ELFs than maximum permissible exposure levels according to the IEEE. The most common observation at high exposures was a decrease in fetal mass. The most common observation at high exposures was a decrease in fetal mass. Lower birthweights, slower growth rates, exencephalies, and other skeletal abnormalities were reported in mice. Lower birthweights, slower growth rates, exencephalies, and other skeletal abnormalities were reported in mice. Teratogenic effects were only observed in animals exposed to levels of radiation causing a thermal effect. Teratogenic effects were only observed in animals exposed to levels of radiation causing a thermal effect.

15. Patients and Methods In this study, thirty pregnant women were recruited from Kasr El Eini Maternity Hospital. In this study, thirty pregnant women were recruited 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 FHR was obtained for 5 minutes with no mobile phones around. FHR was obtained and traced for another 5 minutes while the patient was on conversation mode. Group I: comprised of 15 pregnant women. The FHR was obtained for 5 minutes with no mobile phones around. FHR was obtained and traced for another 5 minutes while the patient was on conversation mode. Group II: comprised of 15 pregnant women. Doppler ultrasound of the umbilical artery was performed and the Resistance Index was traced. The patients were instructed to use the cellular phone on conversation mode for 5 minutes, after which doppler ultrasound of the umbilical artery was performed and the Resistance index was traced. Group II: comprised of 15 pregnant women. Doppler ultrasound of the umbilical artery was performed and the Resistance Index was traced. The patients were instructed to use the cellular phone on conversation mode for 5 minutes, after which doppler ultrasound of the umbilical artery was performed and the Resistance index was traced.

16. Inclusion Criteria No medical disorders or complications of pregnancy No medical disorders or complications of pregnancy Within age group 18 – 35 years of age Within age group 18 – 35 years of age 28-32 weeks gestation 28-32 weeks gestation singleton fetus singleton fetus in cephalic presentation in cephalic presentation

17. Questionnaire A questionnaire was designed and included the following parameters: Personal history Personal history Medical history Medical history Average amount of time spent using cellular phone Average amount of time spent using cellular phone Symptoms reported from usage Symptoms reported from usage Written consent of approval of participation in the research Written consent of approval of participation in the research

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

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

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

21. Discussion: Is It Safe to use a mobile phone during pregnancy? The short answer to this question is that mobile phones are probably safe to use in pregnancy. Research suggests that there is no risk to health from mobile phones in the short term. The short answer to this question is that mobile phones are probably safe to use in pregnancy. Research suggests that there is no risk to health from mobile phones in the short term. However, it is still a good idea to be cautious. Mobile phones have only been in use for a relatively short amount of time, so it's impossible to be certain of their long-term effects yet. However, it is still a good idea to be cautious. Mobile phones have only been in use for a relatively short amount of time, so it's impossible to be certain of their long-term effects yet.

22. Discussion: Is It Safe to use a mobile phone during pregnancy? Cont. Mobiles emit low levels of "non-ionizing" electromagnetic radiation - as do televisions, computers, microwave ovens and other man-made and natural environmental sources that we're exposed to every day. Mobiles emit low levels of "non-ionizing" electromagnetic radiation - as do televisions, computers, microwave ovens and other man-made and natural environmental sources that we're exposed to every day. Non-ionizing" radiation is much milder than the "ionizing" radiation emitted by sources such as x-rays, radiation therapy machines and CT scans, which are known to be harmful to a developing fetus. Non-ionizing" radiation is much milder than the "ionizing" radiation emitted by sources such as x-rays, radiation therapy machines and CT scans, which are known to be harmful to a developing fetus. The amniotic fluid surrounding the fetus might be a proposed thermoregulatory barrier mechanism against the thermal effect produced by cellular phones. The amniotic fluid surrounding the fetus might be a proposed thermoregulatory barrier mechanism against the thermal effect produced by cellular phones.

23. Summary and Conclusions Our study suggests that there are no risks to fetal well being in the short term. Our study suggests that there are no risks to fetal well being in the short term. Although reassuring about the safety of the technology in the short term, impossible to reach conclusive evidence regarding long term cumulative effects. Although reassuring about the safety of the technology in the short term, impossible to reach conclusive evidence regarding long term cumulative effects.

24. Recommendations use your phone as little as possible, and only when you have no alternative - send a text or use a landline instead. use your phone as little as possible, and only when you have no alternative - send a text or use a landline instead. keep your calls short ! keep your calls short ! try to avoid using your phone if the signal strength is low. try to avoid using your phone if the signal strength is low. hands-free kit can reduce the SAR for your head while you're on the phone but may increase the SAR for the rest of your body, something you might want to avoid while you are pregnant. hands-free kit can reduce the SAR for your head while you're on the phone but may increase the SAR for the rest of your body, something you might want to avoid while you are pregnant.

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