Low-dose ionizing radiation and adverse birth outcomes: a systematic review and meta-analysis

OBJECTIVE: Ionizing radiation is a human carcinogen, and there is evidence that exposure to low-dose ionizing radiation increases the risk of adverse birth outcomes. METHODS: We undertook a systematic review and meta-analysis to synthesize the research of maternal and paternal exposure to low-dose radiation on low birth weight, miscarriage, pre-term delivery, and stillbirth. Our literature search used four databases (PubMed, Environmental Index, GeoBASE, and the Cumulative Index to Nursing and Allied Health Literature). We included study populations exposed to occupational and medical sources of radiation, nuclear disasters, and those living near nuclear power plants. We considered papers published between January 1st, 1990, and June 30th, 2021. The quality of the studies was assessed, and we performed meta-analysis using random effects models to generate summary measures of association. Forest plots were created to assess the heterogeneity in these measures, and funnel plots were used to assess publication bias. RESULTS: Overall, 26 studies were identified, and these yielded measures of association from 10, 11, and 8 studies for low birth weight, miscarriage, and stillbirth outcomes, respectively. It was not possible to perform meta-analyses for pre-term delivery due to a small number of studies. The meta-analysis summary relative risk (RR) of having a low-birth-weight infant among those ever exposed to radiation relative to those unexposed, after adjusting for publication bias, was 1.29 (95% CI 0.97–1.73). The corresponding risk estimates for miscarriage and stillbirth were 1.15 (95% CI 1.02–1.30), and 1.19 (95% CI 0.98–1.45), respectively. CONCLUSIONS: Our findings suggest that ionizing radiation increases the risk of adverse birth outcomes. Future work should strive to provide data needed to better understand the shape of the exposure–response curve. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00420-022-01911-2.