Objective To systematically evaluate guidelines on physical activity for pregnant women with Gestational Diabetes Mellitus (GDM), to compare the similarities and differences in recommendations between these guidelines, so as to provide a reference for promoting physical activity of this population. Methods Domestic and international guidelines networks, websites of specialist associations related to diabetes, obstetrics and gynecology, as well as databases, were systematically searched from January 2009 to March 2025.Two appraisers used the Appraisal of Guidelines for Research & Evaluation II to evaluate the quality of guidelines, and then used the content analysis method to synthesize the recommendations of each guideline and compare similarities and diffe-rences. Results A total of 21 guidelines were included in this study, of which 12 as grade A, 6 as grade B and 3 as grade C.A total of 93 recommendations were extracted, of which 49 recommendations provided with strength of recommendation or level of evidence.24.7% of recommendations were strong and 84.2% of evidence level were low or very low.Finally, 36 recommendations were categorized in four aspects:pre-exercise assessment for pregnant women with GDM, individualized suggestions, detailed exercise recommendations, and precautions during the exercise process, and there were notable differences on frequency, intensity and form of physical activity among guidelines. Conclusion The whole quality of guidelines on physical activity for pregnant women with GDM are fair, and there are significant differences in the recommendations on exercise frequency, intensity and form.In the future, high-quality studies should be conducted on the effects of different exercise programs on blood glucose control and maternal and infant outcomes for pregnant women with GDM.The guidelines should provide individualized decision-making suggestions on the frequency, intensity, and form of physical exercise for pregnant women with GDM.