Objective：To analyze the characteristics and pregnancy outcomes of pregnant women with gestational diabetes mellitus （GDM）combined with thrombocytopenia，and to explore the influencing factors of the main adverse pregnancy outcomes. Methods： Pregnant women with GDM combined with thrombocytopenia who delivered in the First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2024 were systematically screened. Maternal characteristics，including baseline，previous medical history，prenatal laboratory examinations，as well as maternal and neonatal outcomes，were analyzed. Logistic regression analysis was employed to identify the factors influencing the main adverse pregnancy outcomes. Results：A total of 233 women with GDM combined with thrombocytopenia were screened，accounting for 3.8‰ of all pregnant women. The mean maternal age was 31.95 years. Among them，51.5% had a history of miscarriage，and 30.5% had other co -morbidities. In terms of pregnancy outcomes，there were 132 cases（56.7%）of cesarean section，38 cases（16.3%）of premature rupture of membranes，30 cases（12.9%）of postpartum hemorrhage，and 26 cases（11.2%）of preterm delivery. In terms of neonatal outcomes，there were 24 cases（10.3%）of macrosomia，13 cases（5.6%）of low birth weight，12 cases（5.2%）of neonatal asphyxia，17 cases（7.3%）of hyperbilirubinemia，and a total of 43 cases （18.5% ）were transferred to the neonatal intensive care unit（NICU）. The multivariate logistic regression analysis showed that comorbidities（OR=4.71，P=0.014）and fasting blood glucose（OR=2.48，P=0.044）were independent risk factors for preterm delivery in pregnant women with GDM combined with thrombocytopenia. Prenatal D-dimer（OR=1.25，P=0.005）and platelet levels（OR=0.98， P=0.012）were significantly correlated with the risk of postpartum hemorrhage. In addition，higher body mass index in late pregnancy （OR=1.22，P=0.039）and fasting blood glucose（OR=1.93，P=0.047）independently impacted the risk of macrosomia. Conclusion： Pregnant women with gestational diabetes mellitus combined with thrombocytopenia are at higher risk of adverse maternal and infant pregnancy outcomes such as postpartum hemorrhage，preterm delivery，and macrosomia. For such pregnant women，comprehensive measures should be actively taken to control blood glucose，correct thrombocytopenia，and choose an appropriate mode of delivery to improve maternal and infant outcomes.