Objective: This study focuses on pregnant women with gestational diabetes mellitus (GDM) combined with thrombocytopenia, aiming to analyze their characteristics and pregnancy outcomes and reveal 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 abortion, and 30.5% had other co-morbidities. In terms of maternal pregnancy outcome, 56.7% of them underwent the cesarean section. Additionally, 38 women (16.3%) experienced premature rupture of membranes, 30 (12.9%) had postpartum hemorrhage, and 26 (11.2%) had preterm delivery. Regarding neonatal outcomes, 24 newborns (10.3%) were macrosomia, 13 (5.6%) had low birthweight, 12 (5.2%) experienced neonatal distress, 17 (7.3%) had hyperbilirubinemia, and a total of 43 (18.5%) neonates were transferred to NICU. The multivariate logistic regression analysis showed that co-morbidities (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 diabetes and 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 such as health education, dietary adjustments, moderate exercise, and medication treatment should be actively taken during pregnancy to control blood glucose and correct thrombocytopenia. Doctors and midwives should choose the appropriate mode of delivery to improve maternal and infant outcomes.