Commentary by ARPANSA:There are a number of methodological issues with this review that indicate the authors have not fully assessed the evidence and may have omitted evidence contrary to their desired conclusions. Although the authors mention that they conducted a systematic review and describe in the methods how it was conducted, the results do not indicate a properly conducted systematic review. Although the studies are given a risk of bias (RoB) rating the full RoB analysis is not presented and it is noted that the authors rate poor quality studies as being high quality. Also, systematic reviews only include original research papers, but Al-Jarrah and Rababa include a meta-analysis in the final list of included studies [Tsarna et al, 2019]. There was also no formal synthesis of results presented. Further, the authors mix in vitro, in vivo, epidemiological, and human experimental studies which would require separate systematic reviews. Instead, the authors present a biased narrative review.
The authors only assessed papers published in the last 5 years and there is no justification for the selection of this timeframe. This is a major source of bias as it excludes many modern high-quality papers on EMF and health. This short time frame for inclusion again highlights how the authors have ignored evidence on this topic. Additionally, the screening process as reported is flawed. The authors reportedly found 10,450 articles from 7 databases and yet only 311 articles remained after duplicates were removed meaning 10,139 articles were duplicates. This cannot be correct. Furthermore, the search strings used for each database search are not presented, nor is the number of articles retrieved from each database.
The authors’ assessment of pregnancy outcomes included nine papers. Of these, eight had clear limitations in their methods, particularly when assessing exposure that would prevent any causal association being made, and the other paper was a measurement study that was not assessing health outcomes. The authors of this review seem to have ignored these limitations when assessing the evidence of the included studies.
Overall, this review by Al-Jarrah & Rababa failed to fully or adequately assess the available evidence on the impact of EMF on health and pregnancy outcomes. It also relied on papers with low quality methods and poor exposure assessment. Another recent review by Ashrafinia et al (2021) of higher quality studies assessed the impact of mobile phone exposure and adverse maternal, infant and child outcomes and reported no substantiated evidence of an impact from mobile phone exposure. It appears that the authors have “cherry picked” articles that suited their narrative and ignored or rejected papers that didn’t, as studies that did not find an association included in the Ashrafinia et al review were not included in this review despite being within the dubious 5-year timeframe. The particular papers that have been inexplicably excluded from the Al-Jarrah & Rababa review but are present in the Ashrafinia et al review include Sudan et al (2016), Papadopoulou et al (2017), and Choi et al (2017). Furthermore, a major review by the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) published in 2015 also found no substantiated evidence of a health impact from EMF exposure [SCENIHR, 2015].
