Start with instructions about vitamin and mineral supplements

There is no indication that pregnant women with overt DM or GDM should not follow the same guidelines for nutrient intakes that are indicated for all pregnant women, with the exception of folic acid supplementation for which there is theoritical benefit to be achieved by taking higher than usual doses. Thefore:

R 1.4, R 4.4 Recommend daily dose of folic acid 5 mg, ideally started 3 months before conception and till 12w (2++). Then suggest dose reduction to 0.4-1 mg which should be continue until the completion of breast feeding. (2++)

R 1.4, R 4.4 Recommend pregnant women with overt DM or GDM should follow the same guidelines for the intake of minerals and vitamins as for women without diabetes. (1++) 

In the meanwhile provide advice about medical nutrition and exercise

Map: Management of overt diabetes (DM) and gestational diabetes (GDM) (305)
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