Objective To describe the status of blood glucose management decision-making behavior of pregnant women with gestational diabetes mellitus(GDM)and to explore its influencing factors. Methods A total of 1 127 pregnant women with GDM from 6 hospitals in Shanghai and Jiangsu province were investigated with the blood glucose management protection motivation questionnaire,knowledge questionnaire,decision-making behavior questionnaire and general information questionnaire. Results The score of decision-making behavior in blood glucose management of pregnant women with GDM was 69.30±6.85,which is at a high level. Gestational age,vulnerability,severity,response efficacy,self-efficacy and response costs were influencing factors of blood glucose management decision-making behavior in pregnant women with GDM(P<0.05). Conclusion Nursing professionals should strengthen GDM pregnant women’s protection motivation of blood glucose management,especially for women who during the third trimester. This study suggested that GDM women’s decision-making behavior of blood glucose management could be improved through increasing patient’s cognition of disease severity and vulnerability,enhancing response efficacy and self-efficacy,and reducing response costs.