A exposição pré-natal e pós-natal a telefones celulares pode aumentar os resultados adversos para mães, bebês e crianças?

Ashrafinia, Farzaneh; Moeindarbari, Somayeh; Razmjouei, Parisa; Ghazanfarpour, Masumeh; Najafi, Mona Najaf; Ghalibaf, Amir Ali Moodi; Abdi, Fatemeh

doi:10.1055/s-0041-1736173

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Sumário

Review Article • Rev. Bras. Ginecol. Obstet. 43 (11) • Nov 2021 • https://doi.org/10.1055/s-0041-1736173 copiar

A exposição pré-natal e pós-natal a telefones celulares pode aumentar os resultados adversos para mães, bebês e crianças?

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo

Determinar a associação entre o uso de telefone celular pela mãe e os resultados adversos em recém-nascidos crianças e mães.

Método

Em março de 2020 realizou-se uma pesquisa nas bases de dados MEDLINE, Embase e Scopus. A extração de dados e avaliação da qualidade dos estudos foram realizadas por dois autores. A qualidade dos estudos foi avaliada por meio da lista de verificação da escala Newcastle-Ottawa.

Resultados

Estudos que avaliavam problemas comportamentais em recém-nascidos de 6 a 18 meses relataram resultados nulos. No entanto um risco aumentado de transtornos emocionais e comportamentais foi observado em crianças de 7 a 11 anos de idade cujas mães foram expostas a telefones celulares. Os resultados relacionados à associação entre a exposição materna a celulares e resultados adversos em crianças de 3 a 5 anos são controversos. Um estudo encontrou associação significativa entre o tempo de ligação (p=0.002) ou o histórico de uso de celular (emmeses) e distúrbios de fala nas crianças (p=0.003). No entanto outro estudo descobriu que o uso de telefone celular pela mãe durante a gravidez não estava significativamente associado ao desenvolvimento psicomotor e mental da criança. Resultados inconclusivos foram observados com relação aos resultados adversos de fetos como restrição de crescimento intrauterino ou valores de t para peso ao nascer em usuárias de telefone celular em oposição a não usuárias. Pelo contrário os filhos de mães usuárias de telefone celular apresentaram menor risco de pontuação baixa em habilidades motoras.

Resultados

semelhantes foram observados com relação a resultados adversos em recém-nascidos como restrição de crescimento intrauterino ou valores de peso ao nascere o risco de pré-eclâmpsia foimenor em indivíduos comexposição média e alta a celulares em oposição àqueles com baixa exposição.

Conclusão

Estudos sobre problemas comportamentais relataram resultados diferentes no pós-natal como achados nulos em recém-nascidos e associação positiva emcrianças.

Palavras-chave:
celular; resultado materno; resultados em crianças

Author	Year	Country	Study design	Population	Study population	Study duration	Source of information	Disorder diagnosis instrument	Comparison groups	Outcome:relative risk (confidence interval)	Covariate adjustment
Papadopoulou et al.⁴4 Papadopoulou E, Haugen M, Schjølberg S, Magnus P, Brunborg G, Vrijheid M, et al. Maternal cell phone use in early pregnancy and child's language, communication and motor skills at 3 and 5 years: the Norwegian mother and child cohort study (MoBa). BMC Public Health. 2017;17(01):685. Doi: 10.1186/s12889-017-4672-2 https://doi.org/10.1186/s12889-017-4672-...	2017	Norway	Cohort	45,389for child's language, communication, and motor skills;17,310for neurodevelopmental outcomes	Pregnant women at 17–18 weeks of gestational age (used cellphone according to the cellphone use frequency questionnaire) and their children at 3 and 5 years of age	1999–2014	Population-based	Dale and Bishop grammar rating/ ASQ/ CDI	Pregnant women according to cellphone use frequency questionnaire(no use)	Low sentence complexity at 3 years: 0.83 (0.77–0.89);specified language skills: 0.86 (0.79–0.93);low risk of having incomplete grammar: 0.69 (0.59–0.81);modarate language delay: 0.49 (0.30–0.80)	Maternal age (years), maternal education (≤ 12 years/13–16 years/≥ 17 years), parental income (both parents lowincome/either parent high income/both parents high income),parity (primiparous/multiparous), maternal occupation(public sector or military/private sectors or sel-femployed/other), computer screen use during pregnancy(yes/no), marital status (living with partner/other),smoking prior to and during pregnancy (no/occasionally/daily), alcohol consumption prior to and duringpregnancy (never or < 1 time per month/1–3 times permonth/ ≥1 time per week), use of folic acid supplementsduring pregnancy (yes/no), prepregnancy body massindex (< 18.5, 18.5–24.9, 25–29.9, ≥ 30 kg/m²), typeof delivery (c-section/vaginal), and the length of gestation(in weeks)
Divan et al.¹⁰10 Divan HA, Kheifets L, Obel C, Olsen J. Cell phone use and behavioural problems in young children. J Epidemiol Community Health. 2012;66(06):524-529. Doi: 10.1136/jech.2010.115402 https://doi.org/10.1136/jech.2010.115402...	2012	USA	Cohort	28,745	Pregnant women and their children at 7 years of age	1996–2002	Danish Medical Birth Registry	Mother's history of psychiatric problems (self-reported from Age-7 Questionnaire) / SDQ	Pregnant women and their children at 7 years of age without exposure during the same period of the study group.	Prenatal and postnatal exposure: 1.5 (1.4–1.7);prenatal exposure: 1.4 (1.2–1.5);postnatal exposure: 1.2 (1.0–1.3)	Child's gender;mother's age at birth; father's age at birth; mother's history ofpsychiatric problems (self-reported from Age-7 Questionnaire);mother's history of same psychiatric, behavioral, or cognitive problemsas child (self-reported from prenatal interviews); father'shistory of same psychiatric, behavioral, or cognitive problems aschild (spousal report from prenatal interviews); socio-occupational status, including High, Mid, Low;prenatal smoking (entire pregnancy, early pregnancy,or not a smoker); prenatal alcohol intake (entire, early, or latepregnancy only, or not at all); and prenatal marijuana use (yes orno); prenatal stress (14-point summary score categorized as low(0–4), medium (5), or high (6–14)); prenatal physical activity(entire, early, or late pregnancy, or no activity); other sources ofprenatal ionizing and non-ionizing radiation (such as, X-rays, ultrasound);parity; gestational age; birth weight; postpartum stress(15-point summary score categorized as low (0–3), medium(4), or high (5–15)); child breastfed for at least the first 6 months(yes or no); hours spent with child daily by ages 6 and18 months; and child in daycare by 18 months
Choi et al.⁷7 Choi KH, Ha M, Ha EH, Park H, Kim Y, Hong YC, et al. Neurodevelopment for the first three years following prenatal mobile phone use, radio frequency radiation and lead exposure. Environ Res. 2017;156:810-817. Doi: 10.1016/j.envres.2017.04.029 https://doi.org/10.1016/j.envres.2017.04...	2017	South Korea	Cohort	1,198	Pregnant women and their children up to 3 years of age	2006–2010	Mothers and Children's Environmental Health (MOCEH) studyRegistry	Cell phone use frequency questionnaire/ Blood test for lead level/ BSID-II/ exposure meter	Pregnant women according to cell phone use frequency questionnaire	The psychomotor development index (PDI) and the mental development index (MDI) at 6, 12, 24, and36 months of age were not significantly associated with maternal mobile phone use during pregnancy.There was also arisk of having decreasing MDI up to 36 months of age, in relation to an increasing average calling time or frequency during pregnancy (p-trend = 0.05 and 0.007 for time and frequency respectively). There was nosignificant association between child neurodevelopment and prenatal RFR exposure measured	The year of enrollment, center area, and responses to questionsconcerning maternal age at pregnancy (< 30, 30–34, and ≥ 35 years),household income (< 2,000, 2,000–3,000, and ≥ 3,000 103 Korean won (KRW) permonth), whether or not the mother is employed, level of schooling(≤ 12 or > 12 years), and frequency of headset use (never, sometimes,or often to always), gestational age, gender of the infant, birth order, maternalintelligence quotient (IQ), prenatal second-hand smoking exposure, maternal urinary cotinine
Sudan et al.⁸8 Sudan M, Olsen J, Arah OA, Obel C, Kheifets L. Prospective cohort analysis of cellphone use and emotional and behavioural difficulties in children. J Epidemiol Community Health. 2016;70(12): 1207-1213. Doi: 10.1136/jech-2016-207419 https://doi.org/10.1136/jech-2016-207419...	2016	Denmark	Cohort	51,190	Pregnant women and their children at 6 and 8 months, and 7 and 11 years of age	1996–2014	Danish National Birth Cohort (DNBC)Registry	Telephone interview/ Age-7 DNBC questionnaire/ SDQ	Pregnant women according to cell phone use frequency questionnaire(no exposure)	Exposed both prenatally and used cell phones at age 7 years: 1.58 (1.34–1.86);prenatal exposure only:1.41 (1.20–1.66);age-7 use only: 1.36 (1.14–1.63)	Child's gender, mother's age, mother'sand father's history of same psychiatric, cognitive, or behavioral problemsas the child, Socio-occupational status (High, Mid, Low); gestational age atbirth, mother's prenatal stress, and breastfeeding
Vrijheid et al.¹²12 VrijheidM,Martinez D, Forns J, Guxens M, Julvez J, FerrerM, et al. Prenatal exposure to cell phone use and neurodevelopment at 14 months. Epidemiology. 2010;21(02):259-262. Doi: 10.1097/EDE.0b013e3181cb41e0 https://doi.org/10.1097/EDE.0b013e3181cb...	2010	Spain	Cohort	530	Pregnant women and their children at 14 monthes of age	2004–2006	Population-based	Cell phone use frequency questionnaire/BSID-II/ Cattell's intelligence test	Pregnant women according to cellphone use frequency questionnaire	Only small differences in neurodevelopment scores between the offspring of cell phone users and nonusers. Those of users had higher mental development scores and lower psychomotor development scores	Maternal socio-economic status, maternal education, and maternal IQ, mater nal age, maternal smoking at any time during pregnancy, and smoker in the house
Guxens et al.¹⁴14 Guxens M, van Eijsden M, Vermeulen R, Loomans E, Vrijkotte TG, Komhout H, et al. Maternal cell phone and cordless phone use during pregnancy and behaviour problems in 5-year-old children. J Epidemiol Community Health. 2013;67(05):432-438. Doi: 10.1136/jech-2012-201792 https://doi.org/10.1136/jech-2012-201792...	2013	Netherlands	Cohort	2,618	Pregnant women and their children at 5 years of age	2003–2004	Amsterdam-born Children and their Development (ABCD),population -based	Cell phone use frequency questionnaire/ SDQ	Pregnant women according to cell phone use frequency questionnaire(non-user)	< 1 call/day: 2.12 (0.95–4.47)1–4 calls/day: 1.58 (0.69–3.60)≥ 5 calls/day: 2.04 (0.86–4.80)	Maternal age, maternalLevel of schooling (based on the years after primary school: high(≥ 10 years), medium (6–9 years) and low (≤ 5 years)), maternalcountry of birth, maternal parity, maternal prepregnancyweight and height, maternal smoking, maternal second-handsmoking at home, maternal alcohol consumption during pregnancy,maternal pregnancy-related anxiety, and maternal anxietyand depression during pregnancy was obtained by a questionnairecompleted by the mother.

Author	Selection													Comparability		Outcome
	Represent exposed				Selection non exposed			Ascertainment of exposure				Outcome wasn't at start				Assessment				Follow-up long enough		Adequacy of follow-up
	Truly represents community	Somewhat represents community	Selected	None	Same community	Different source	None	Secure record	Structured interview	Self-report	None	Yes	No	Most important	Any additional factor	Independentblind	Record linkage	Self-report	None	Yes	No	Complete	Small no bias	Rate offalloff upno description	None
Papadopoulou et al.(2017)⁴4 Papadopoulou E, Haugen M, Schjølberg S, Magnus P, Brunborg G, Vrijheid M, et al. Maternal cell phone use in early pregnancy and child's language, communication and motor skills at 3 and 5 years: the Norwegian mother and child cohort study (MoBa). BMC Public Health. 2017;17(01):685. Doi: 10.1186/s12889-017-4672-2 https://doi.org/10.1186/s12889-017-4672-...	*	-	−	−	*	−	−	−	−	*	−	*	−	*	−	−	−	*	−	*	−	*	−	−	−
Divan et al.(2012)¹⁰10 Divan HA, Kheifets L, Obel C, Olsen J. Cell phone use and behavioural problems in young children. J Epidemiol Community Health. 2012;66(06):524-529. Doi: 10.1136/jech.2010.115402 https://doi.org/10.1136/jech.2010.115402...	*	−	−	−	*	−	−	−	*	−	−	*	−	*	−	−	−	*	−	*	−	*	−	−	−
Choi et al.(2017)⁷7 Choi KH, Ha M, Ha EH, Park H, Kim Y, Hong YC, et al. Neurodevelopment for the first three years following prenatal mobile phone use, radio frequency radiation and lead exposure. Environ Res. 2017;156:810-817. Doi: 10.1016/j.envres.2017.04.029 https://doi.org/10.1016/j.envres.2017.04...	*	−	−	−	*	−	−	−	−	*	−	*	−	*	−	−	−	*	−	*	−	*	−	−	−
Sudan et al.(2016)⁸8 Sudan M, Olsen J, Arah OA, Obel C, Kheifets L. Prospective cohort analysis of cellphone use and emotional and behavioural difficulties in children. J Epidemiol Community Health. 2016;70(12): 1207-1213. Doi: 10.1136/jech-2016-207419 https://doi.org/10.1136/jech-2016-207419...	*	−	−	−	*	−	−	−	*	−	−	*	−	*	−	−	*	*	−	*	−	*	−	−	−
Vrijheid et al.(2010)¹²12 VrijheidM,Martinez D, Forns J, Guxens M, Julvez J, FerrerM, et al. Prenatal exposure to cell phone use and neurodevelopment at 14 months. Epidemiology. 2010;21(02):259-262. Doi: 10.1097/EDE.0b013e3181cb41e0 https://doi.org/10.1097/EDE.0b013e3181cb...	*	−	−	−	*	−	−	−	−	*	−	*	−	*	−	*	−	−	−	*	−	*	−	−	−
Guxens et al.(2013)¹⁴14 Guxens M, van Eijsden M, Vermeulen R, Loomans E, Vrijkotte TG, Komhout H, et al. Maternal cell phone and cordless phone use during pregnancy and behaviour problems in 5-year-old children. J Epidemiol Community Health. 2013;67(05):432-438. Doi: 10.1136/jech-2012-201792 https://doi.org/10.1136/jech-2012-201792...	*	−	−	−	*	−	−	*	−	*	−	*	−	*	−	−	−	*	−	*	−	*	−	−	−

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[1] Address for correspondence Masumeh Ghazanfarpour, Kerman University of Medical Sciences, Medical University Campus, Haft-Bagh Highway, Kerman, Iran (e-mail: masumeh.ghazanfarpour@yahoo.com).