Objective To investigate the etiology and outcome of gestational thrombocytopenia. Methods The clinical data on 146 cases of gestational thrombocytopenia treated in Beijing Shijitan Hospital between January 2010 and December 2016 was retrospectively analyzed. These patients were divided into three groups: group Ⅰin which the platelet count was above 50×10⁹/L, group Ⅱ in which the platelet count was between (30-50)×10⁹/L, and group Ⅲ whose platelet count was lower than 30×10⁹/L. The cause of disease was explored in order to offer targeted treatment. The platelet count of group Ⅰ was monitored closely. Patients vulnerable to bleeding in groups Ⅱ and Ⅲ were treated with glucocorticoid and had their platelet count dynamically monitored. Importance was attached to perinatal surveillance and postpartum visits so as to find out more about the cause of disease. Results The main causes of gestational thrombocytopenia included pregnancy associated thrombocytopenia (PAT), idiopathic thrombocytopenic purpura (ITP) and pregnancy complications. Gestational thrombocytopenia was one of the most important signs of autoimmune diseases. Patients with platelet counts <30×10⁹/L had a significantly higher rate of cesarean section and platelet transfusion than those with platelet counts of (30-50)×10⁹/L and (50-100)×10⁹/L (P<0.05). Conclusions Clear diagnoses are required in case of gestational thrombocytopenia. Different treatment methods and different ways of delivery should be applied according to etiologies, severity of thrombocytopenia and degree of urgency. Follow-up should last for 3 years after delivery.