Q: I am 31 years old married to a 29 years old female. Both of us have the same blood group - B positive. We are planning for a child. My wife's body mass index is 34.4. Is it possible to plan for an epidural analgesia (painless labour) with such a high BMI? What things should we consider before conception? Also to add, my wife's mother's blood group was O positive. She had a medical history of Erythroblastosis foetalis and had three miscarriages after her first child. The fifth one survived just for 3 months and my wife is her sixth child.

A:Well as far as the blood group is concerned both of you are B Positive, so there is no incompatibility. With respect to the BMI of your wife, obviously she falls into the obese category. Obesity per se is perceived as a risk factor for any procedure especially wherein general anaesthesia is given to the patient. For epidural analgesia this is not a contraindication. However, since the BMI is high the drug dosage required or the top ups for the analgesia might be higher. This can be very well evaluated during antenatal checkups. Also, one needs to know that extension of labour epidural analgesia to epidural anaesthesia for Caesarean Section may be either difficult or not possible. Obesity is one of the most frequent causes for complications in pregnancy. The mother is considered obese if at the beginning of her pregnancy her BMI is over 25 units. Of particular concern for women of childbearing age are the effects that obesity can have on your reproductive health. Not only can obesity put you and your baby at risk for some serious health complications, but also it can actually interfere with fertility. This is because fat stores change the levels of sex hormones that your body produces, making it increasingly difficult to become pregnant. The obese woman has a greater predisposition to contract two very serious diseases. They are: arterial hypertension and diabetes mellitus. There are also other problems such as:

1. It is much more difficult to visualize the product through ultrasonography due to excessive body fat.
2. When there is excessive body fat it is much more difficult to practice a diagnostic amniocentesis.
3. It is much more difficult to evaluate and follow an anaesthesia technique .
4. The risk of complications rises.
5. It is much easier to cause infection.
6. Urinary infections are more frequent.

1. Increased likelihood of a caesarean section,
2. Chances of a prolonged labour,
3. Increased risk of dystocia (dystocia is difficulty encountered in the delivery of shoulder of the baby).
4. Obesity could lead to gestational diabetes,
5. May cause certain problems in children (Macrosomia, Neural tube defects, Childhood obesity),
6. Increased chances of fetal abnormalities,
7. Difficulty in hearing fetal heartbeat.

• Lose Weight Before Pregnancy: If you are planning on getting pregnant in the near future, get your weight evaluated by your doctor. If you are obese, consider losing weight through proper diet and exercise. Even minimal weight loss can help to radically reduce your risk of pregnancy complications. Those who are severely obese may want to consider obesity surgery.
• Watch your Weight Gain: Even if you are obese, you should never try to lose weight during pregnancy. Weight loss or changes in diet can prevent your baby from getting the calories and nutrients it needs to grow properly. Instead, focus on gaining weight in moderation. Most obese women need to gain between 15 and 25 pounds, putting on the majority of the weight during the third trimester.
• Exercise: Exercise should be continued throughout your pregnancy. Talk with your doctor about exercise levels that would be appropriate for you. Even if it’s just walking around the block a few times, exercise can really help to reduce your risk of potential health complications.