| Summary: | Background: Water intake and hydration status may potentially influence maternal and child health. However, there is little research regarding this topic. Objectives: This study aimed to investigate pregnant women’s total fluid intake (TFI) levels, hydration status, and body composition and further explore their relationship with infant birth weight. Methods: A 7-day, 24 h fluid intake recorded was applied to determine participants’ TFI levels. Morning urine samples were collected and tested to evaluate their hydration status. Maternal body compositions in their third trimester and infant birth weights were measured. Results: A total of 380 participants completed the study. The TFI was insufficient for pregnant women during their third trimester (median = 1574 mL), with only 12.1% of participants meeting the recommended adequate fluid intake level for pregnant women living in China (1.7 L per day). With the increasing TFI values, the urine osmolality decreased, which showed statistical significance among the four groups (χ<sup>2</sup> = 22.637, <i>p</i> < 0.05). The participants displayed a poor hydration status. Meanwhile, the percentage of participants who were in dehydrated status decreased (χ<sup>2</sup> = 67.618, <i>p</i> < 0.05), while body water content and basal metabolic rate increased with the increase in TFI levels (χ<sup>2</sup> = 20.784, <i>p</i> < 0.05; χ<sup>2</sup> = 14.026, <i>p</i> < 0.05). There were positive linear relationships between plain water intake, the basal metabolic rate of pregnant women and their infant birth weight (SE = 0.153, <i>p</i> < 0.05; SE = 0.076, <i>p</i> < 0.05). Conclusions: Water intake was insufficient, and poor hydration status was common among pregnant women in China. There may be potential relationships between plain water intake, basal metabolic rate, and infant birth weight.
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