Dr. Zeena Helmi

Weight, Fertility & Pregnancy: Why Obesity Must Be Treated Before Conception

As obesity increasingly affects women’s health across the region, its impact is being felt far beyond aesthetics, particularly in fertility, pregnancy outcomes, and long-term maternal health. On the sidelines of the Novo Nordisk iDOL Summit in Dubai, HOSPITALS Magazine spoke with Dr. Zeena Helmi, Fertility Specialist in Obstetrics, Gynecology, and Reproductive Medicine, about the critical link between weight, hormones, fertility, and safe pregnancy, and why managing obesity should start before conception, not after.

From your perspective as a fertility specialist, how serious is the impact of obesity on women’s health in our region?

The impact is extremely serious, and we see it every day in clinical practice. Obesity is not only linked to general health problems, but very directly to fertility, hormonal balance, and pregnancy outcomes. One of the most common examples is polycystic ovary syndrome (PCOS), which is strongly associated with excess weight. In many cases, weight reduction alone, whether through lifestyle measures or modern medical treatments, significantly improves ovulation, hormonal balance, and sometimes even leads to spontaneous pregnancy without further intervention. Unfortunately, many women still see obesity as a cosmetic issue, while in reality it is a medical condition that affects fertility, pregnancy, and long-term health.

How do these patients usually present to you? Do they come asking to lose weight?

Most of them do not come asking to lose weight. They usually come because of a medical problem: infertility, irregular menstrual cycles, excessive hair growth, or symptoms related to PCOS.

When we investigate and reach the diagnosis, we often find that excess weight is a central part of the problem. At that point, weight reduction becomes the first line of treatment, not for aesthetic reasons, but for medical and hormonal reasons.

What are the most common reproductive issues linked to obesity?

The most frequent problems are infertility, irregular or absent ovulation, abnormal menstrual cycles, and hormonal disturbances such as those seen in PCOS. Hirsutism, or excessive hair growth, is also common. All of these are signs of hormonal imbalance, and very often, weight reduction plays a key role in correcting them.

Does obesity also complicate pregnancy itself?

Yes, very much so. Obesity increases the risk of many complications during pregnancy, including gestational diabetes, hypertension, and preeclampsia. It also increases the risk of difficult labor, cesarean delivery, and neonatal complications.

Even after delivery, obese patients are more likely to face medical complications. This is why we strongly prefer to manage weight before pregnancy, not during pregnancy.

How do you approach weight management in women who want to become pregnant?

When a patient is obese and seeking pregnancy, I usually advise her to postpone conception for a few months and focus first on weight reduction.

We work on weight management either directly in the clinic or in collaboration with nutritionists and, when needed, endocrinologists. If medical treatment is used, it must be stopped at least two months before trying to conceive, because these medications are not allowed during pregnancy. The goal is to enter pregnancy in the best possible metabolic and hormonal condition.

In which cases does weight loss become a medical necessity before fertility treatment?

We always start by measuring BMI and evaluating the patient’s overall health. If she is obese, we usually postpone fertility treatment and focus first on weight reduction.

This is not a punishment or a delay for no reason. It is a medical decision to improve her chances of success and to reduce the risks for both the mother and the baby.

How do women usually respond to modern weight-management treatments?

Many patients feel encouraged when they start seeing results. Once they notice real weight reduction, their motivation and commitment increase significantly. This positive feedback loop is very important, because sustained weight management requires long-term commitment, not just a short-term effort.

We often hear that fertility and pregnancy management should be multidisciplinary. How does this work in practice?

It is absolutely a multidisciplinary approach. I often work with endocrinologists, nutritionists, and other specialists depending on the patient’s condition. As a gynecologist, I follow the patient closely, but metabolic and hormonal issues often require a team approach to achieve the best results, especially in complex cases.

What is your main message to women who want to get pregnant but are overweight or obese?

Pregnancy should be a planned decision, not an accident. There are many things that should be prepared before pregnancy: checking for medical conditions, starting supplements like folic acid, and optimizing overall health. Today, obesity is one of the important medical conditions that must be addressed before conception.

Managing weight before pregnancy is not only better for fertility, but also for the health of the mother and the baby.

How do you manage weight during pregnancy itself, knowing that weight gain is normal?

Weight gain during pregnancy is normal, but it should be controlled. I monitor my patients’ weight regularly, usually on a monthly basis.

If weight gain becomes excessive, we intervene with dietary guidance, because we cannot use weight-loss medications during pregnancy. The goal is to maintain a healthy balance, not to allow uncontrolled weight gain.

What about gestational diabetes? How does pre-pregnancy weight influence this risk?

Pre-pregnancy obesity is a major risk factor for gestational diabetes, especially in our region, where diabetes is already very prevalent. I routinely screen most patients during pregnancy, usually around the middle of gestation. If gestational diabetes is diagnosed, the patient is managed with a special diet, sometimes medication, and in collaboration with an endocrinologist to ensure optimal blood sugar control until delivery.

What is the ideal weight gain during pregnancy?

On average, about one kilogram per month is a reasonable target for many women, leading to approximately nine kilograms over the course of the pregnancy. Of course, this can vary depending on the patient’s starting weight and medical condition.

Finally, how do you see the future of weight management in women’s health?

I believe weight management will become an even more central part of women’s healthcare, not only for fertility, but for long-term hormonal, metabolic, and cardiovascular health. If we treat obesity early and seriously, we can improve not only pregnancy outcomes, but the overall health trajectory of women for many years to come.