Maternal Prepartum Intravenous Fluid Administration is associated with Neonatal Weight Loss at day 2 of life

Maternal Prepartum Intravenous Fluid Administration is associated with Neonatal Weight Loss at day 2 of life | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Maternal Prepartum Intravenous Fluid Administration is associated with Neonatal Weight Loss at day 2 of life Anna Mimran, Constance Marié, Pierre Tourneux This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8107573/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Maternal intravenous fluid administration during labor is widely used for treatment administration and to ensure adequate uteroplacental perfusion. Its potential effects on neonatal outcomes, particularly early weight loss, are not fully understood, with data mainly derived from breastfed infants. Evidence in formula-fed infants remains lacking. We aimed to evaluate the impact of prepartum maternal fluid administration on 48-hour weight loss in exclusively formula-fed newborns. Blood cord haematocrit was also studied as a reflect of neonatal potential blood dilution. Methods This retrospective, observational study was conducted at Amiens-Picardie University Hospital between September and December 2024. Term singleton infants exclusively formula-fed during the first two days of life were included. Maternal intravenous fluid volumes during the 12 hours preceding delivery were recorded. Primary outcome was neonatal weight loss at day 2. The secondary outcome was blood cord hematocrit. Results Among 200 mother-infant dyads, maternal fluid loading > 4 mL/kg in the 4–6 hours before delivery was significantly associated with greater neonatal weight loss at 48 hours (p = 0.0168 and p = 0.027, respectively). Oxytocin exposure was also associated with an increased weight loss (p = 0.036). Higher fluid intake > 2 mL/kg in the 2 hours before delivery correlated with lower cord haematocrit (p = 0.024). Conclusion A higher maternal intrapartum fluid administration was associated with an increased neonatal weight loss and a lower blood cord hematocrit in formula-fed infants. These findings support the hypothesis of transient neonatal fluid overload followed by diuresis, and underline the need to account for maternal fluid balance when interpreting early neonatal weight changes. Newborn infant delivery birthweight Diuresis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 What is Known Neonatal weight loss in breastfed newborns is associated with lactation initiation success and maternal intrapartum fluid administration What is New: In formula-fed newborns, higher maternal fluid intake before delivery is significantly associated with greater neonatal weight loss and transient hemodilution, highlighting a direct hydric effect independent of feeding intake. INTRODUCTION Obstetric labor is a complex physiological and medical process involving a cascade of events ensuring a safe birth for both mother and child [ 1 , 2 ]. Common interventions during this period may include pelvic examinations [ 3 ], artificial rupture of membranes [ 4 ], administration of oxytocin [ 5 ], fetal monitoring [ 6 ] and intravenous fluid administration. Maternal intravenous fluid loading is frequently used to prevent hypotension [ 7 , 8 ], improve placental perfusion, and support effective labor progression [ 9 ]. Severe or prolonged maternal hypotension may impair uteroplacental perfusion and lead to significant maternal and fetal complications [ 10 ]. However, the neonatal consequences of maternal fluid administration - particularly potential transplacental water transfer resulting in a secondary early neonatal weight loss - remain insufficiently explored [ 11 , 12 ]. This early weight loss, typically occurring within the first 48 to 72 hours of life, is a well-described phenomenon [ 13 – 16 ], influenced by factors such as gestational age, mode of delivery, time of birth, neonatal metabolic adaptation and certain maternal characteristics [ 17 – 19 ]. Nevertheless, excessive weight loss can lead to neonatal complications, including dehydration and hyperbilirubinemia, which may require specific medical intervention [ 20 – 23 ]. Previous studies have investigated neonatal weight loss in the context of exclusive breastfeeding. Some have shown greater weight loss following cesarean delivery [ 16 ], or an association between the volume of intrapartum maternal fluids and neonatal diuresis [ 24 ]. However, to our knowledge, the impact of prepartum maternal fluid administration on newborn fed with formula has not yet been studied. A better understanding of the impact of these obstetric practices could improve the clinical interpretation of early neonatal weight loss, guide appropriate monitoring, and improve the discharge plan from the maternity ward. These findings could also contribute to update of local guidelines regulating intrapartum intravenous fluid management. The primary objective of this study was to assess the effect of maternal intrapartum fluid administration on neonatal weight loss during the first 48 hours of life. Secondary objectives included exploring the association between maternal fluid intake and two other parameters correlated with neonatal hemodilution: Blood cord hematocrit and the occurrence of jaundice within the first 48 hours. MATERIAL AND METHODS Study Design This was a monocentric, retrospective observational study conducted in the maternity ward of Amiens-Picardie University Hospital. The study protocol was approved by the Clinical Research Department of Amiens-Picardie University Hospital and registered by the Data Protection Officer (ID-RCB: 2208336). A written informed consent letter was delivered to all the mothers prior to inclusion. Study population Patients who delivered between September 1, 2024, and December 31, 2024, were eligible for inclusion. Inclusion criteria were: Maternal age ≥ 18 years; Enrollment in a national health insurance system; Term delivery (≥ 37 + 0 weeks of gestation); Singleton pregnancy; Newborn exclusively fed with infant formula during the first two days of life according to the unit protocol. Non-inclusion criteria were: Refusal to participate in the study; Mothers under legal guardianship; Inability to understand French; Refusal to allow use of personal data for research purposes; Exclusive or mixed breastfeeding; Maternal fluid resuscitation due to hemodynamic instability within 12 hours prior to delivery; Newborns with orofacial clefts, renal pathology, or congenital hydrops; Neonatal death before 30 days of life; Incomplete or inaccurately documented medical records. Data collection The primary outcome was neonatal weight loss at 48 hours of life compared to the birth weight, expressed as a percentage: (Weight at 48h – Birth weight) / Birth weight. Secondary outcomes included: Umbilical cord hematocrit (%). Independent variables assessed were: Maternal fluid administration: cumulative hourly fluid volumes (mL) (standard infusion line, oxytocin or other medications) in the 12 hours before delivery; Maternal factors: age, gravidity, parity, weight, height, body mass index (BMI), gestational weight gain, relevant medical history (hypertension, diabetes, thyroid disorders), smoking status; Obstetric factors: fetal heart rate anomalies, mode of delivery (spontaneous vaginal, instrumental, scheduled or emergency cesarean), labor (spontaneous, balloon catheter, oxytocin, misoprostol), type of anesthesia (spinal, epidural, combined, or general); Neonatal factors: sex, Apgar scores at 1, 5, and 10 minutes. Data were extracted from the electronic maternal and neonatal records (DxCare®, Dedalus) and the OBTRACEVUE® software (Philips®). Statistical Analysis The primary analysis aimed to investigate the association between neonatal weight loss at 48 hours and maternal fluid administration. Infused fluid volumes administered to the mother were normalized to maternal body weight (mL/kg) to define exposure subgroups. The mean neonatal weight loss at 48 hours for a maternal fluid administration of 1 to 2 mL/kg/h (normal hydration) was considered as a reference and thus compared to higher hydration groups for different time points (2h, 4h and 6h prior to delivery). Normality of continuous variables was assessed using the Shapiro–Wilk test. Variance homogeneity was evaluated both visually and using standard deviations. For normally distributed data, comparisons between two groups were made using Student’s t-test, and comparisons among more than two groups were performed using one-way ANOVA. If significant, post hoc analysis was conducted with Tukey’s test. For non-parametric data, the Kruskal–Wallis test was used. Results are reported as means ± SEM for continuous variables. A two-sided p-value < 0.05 was considered statistically significant. RESULTS Population Characteristics A total of 200 mother-infant dyads were included. The mean maternal age was 28.8 ± 4.3 years. The mean maternal weight at the end of pregnancy was 82.9 ± 14.1 kg, with an average gestational weight gain of 11.5 ± 5.1 kg. The mean gravidity was 2.65 ± 1.42, and the mean parity was 2.06 ± 0.89. The average duration of prepartum intravenous fluid administration was 5.64 ± 3.79 hours. Mean fluid volumes administered were 173.4 ± 75.5 mL in the 2 hours, 309.9 ± 161.8 mL in the 4 hours, and 410.0 ± 249.8 mL in the 6 hours preceding delivery. Labor was mainly spontaneous (n = 134/200) (Table1). Epidural analgesia was administered in 79% of women (n = 158). The mean birth weight was 3295 ± 359 g and 3157 ± 346 g on day 2 of life (-4.16% ± 1.73%). Newborn infants were female in 46% (n = 92). Most deliveries occurred via vaginal route (75.5%) (Table 1). Table 1 Maternal, obstetric and neonatal characteristics Variable Study population Min - Max Mother’s age (years) 28.8 ± 4.3 18 – 42 Mother’s height (m) 1.65 ± 0.05 1.49 – 1.87 Mother’s weight closest to delivery (kg) 82.85 ± 14.12 49 – 139 Weight gain during pregnancy (kg) 11.5 ± 5.13 -13 – 28 BMI 30.43 ± 4.91 18.02 – 50.47 Gestation 1 2 3 4 >5 2.65 ± 1.42 65 (32,5%) 54 (27%) 32 (16%) 22 (11%) 27 (13.5%) 1 – 13 Parity 1 2 3 4 >5 2.06 ± 0.89 81 (40.5%) 67 (33.5%) 26 (13%) 13 (6.5%) 12 (6%) 1 – 6 Smoking during pregnancy Yes No 48 (24%) 152 (76%) History of high blood pressure Yes No 4 (2%) 196 (98%) History of diabetes Yes No 3 (1.5%) 197 (98.5%) Gestational diabetes Yes No 27 (13.5%) 173 (86.5%) Maternal intrapartum fluid administration Duration (h) Volume at H2 (mL) Volume at H4 (mL) Volume at H6 (mL) 5.64 ± 3.79 173.39 ± 75.46 309.93 ± 161.8 410.03 ± 249.78 0 – 32.52 0 – 470 0 – 900 0 - 1330 Anesthesia None Epidural Spinal anesthesia General anesthesia 23 (11.5%) 158 (79%) 20 (10%) 1 (0.5%) Induction of labor Pharmacological Oxytocin Misoprostol Non-pharmacological Intracervical balloon Spontaneous 56/200 17/200 39/200 144/200 10/200 134/200 Method of delivery Vaginal delivery Cesarean 151 (75.5%) 49 (24.5%) Newborn sex Female Male 92 (46%) 108 (54%) Hematocrit (%) Missing 51.57 ± 3.96 10 17.90 – 64.30 Birth weight (g) 3295.20 ± 359.12 2140 – 4700 Weight at two days old (g) 3157.46 ± 346.03 2060 – 4570 Neonatal jaundice Yes No 14 (7%) 186 (93%) Fluid Volume and Neonatal Weight Loss No significant association was observed between the fluid volume administered to the mother in the 2 hours before delivery and the neonatal weight loss (-3.58%, -3.80% and -4.18% for 1-2 mL/kg, 2-4 mL/kg and >4mL/kg conditions respectively) (Fig1a). However, the neonatal weight loss was significantly greater when the fluid volume administered to the mother exceeded 4 mL/kg over the 4 hours prior to the delivery (p = 0.0168) (Fig1b), and 6 mL/kg over the last 6 hours (p = 0.027) (Fig1c). Effect of Labor Induction Method on neonatal weight loss Newborn infants from mothers who received intravenous oxytocin had a significantly greater weight loss on day 2 compared to those whose mother had non-pharmacological labor induction (spontaneous or balloon catheter) (p = 0.036) (Fig2). Effect of maternal anesthesia Type The type of maternal anesthesia (epidural, spinal, or no anesthesia) was not significantly associated with neonatal weight loss on day 2 (Fig3a). However, the volume of fluids administered in the six hours before delivery was significantly higher in patients who received epidural analgesia (p < 0.05) (Fig3b). Effect of the Mode of Delivery The mode of delivery (vaginal or cesarean) was not significantly associated with neonatal weight loss on day 2 (Fig4). Influence of Other Maternal Factors on neonatal weight loss No significant association was found between neonatal weight loss on day 2 and maternal age, BMI, gestational weight gain, gravidity or parity. Umbilical Cord Hematocrit A fluid volume administration > 2 mL/kg in the two hours preceding the delivery was significantly associated with a lower umbilical cord blood hematocrit (p < 0.05) (Fig5a). No significant difference was observed for fluid volume administrations over the 4-hour or 6-hour periods (Fig5b and Fig5c). DISCUSSION This study highlights a significant association between maternal intrapartum intravenous fluid administration and neonatal weight loss on the second day of life. This relationship appears to be dose-dependent, with a threshold effect observed from 4 mL/kg over 4 hours and 6 mL/kg over 6 hours. No significant association was found for fluid volumes infused in the last 2 hours before delivery. These findings suggest a possible influence of maternal fluid balance on early neonatal hydration, independent of the mode of delivery. Population Characteristics The average birth weight observed was consistent with previously published data, generally around 3300 g [ 25 – 29 ]. This homogeneous cohort, which excluded breastfeeding, allowed better isolation of the effect of maternal fluid administration compared to a variable feeding volume intake for the breastfeeding infants. Maternal characteristics (age, BMI, gravidity, parity) were not significantly associated with neonatal weight loss, supporting the hypothesis of a direct effect of intrapartum hydration. Impact of Maternal Fluid Administration on Neonatal Weight Loss The observed correlation between maternal intravenous fluid administration and neonatal weight loss aligns with known pathophysiological mechanisms. The mean weight loss in our cohort (-4.16% ± 1.73%) was slightly below the classical thresholds reported for exclusively breastfed infants (5–7%) [ 25 – 27 , 30 , 31 ], but close to previous data focusing on formula fed newborn infants [ 14 ]. Several authors have proposed that maternal fluid infusion may result in a transplacental water transfer, transiently increasing fetal hydration [ 32 – 34 ]. This fluid overload at birth may then be followed by rapid postnatal diuresis, accounting for the increased weight loss [ 24 ]. In addition, we observed that these higher volumes were significantly associated with a decrease in umbilical cord hematocrit, reinforcing the hypothesis of neonatal hemodilution secondary to maternal overhydration [ 32 – 34 ]. This objective biological marker provides additional evidence in support of a direct physiological link. Influence of Obstetric Practices: Induction and Anesthesia Weight loss was significantly greater in neonates born following induction with intravenous oxytocin compared to non-pharmacological induction. This may be due to more frequent use of intravenous fluids during pharmacological labor induction. This potential confounding factor underlines the interaction between obstetric practices and maternal fluid balance. In contrast, the mode of delivery (vaginal or cesarean) was not significantly associated with neonatal weight loss. Epidural anesthesia was associated with significantly higher volumes of intravenous fluids, in line with anesthesic recommendations to prevent maternal hypotension [ 10 , 38 , 39 ]. However, no direct association was found between the type of anesthesia and weight loss on day 2, suggesting that the observed effect is likely mediated by the total fluid administered volume rather than the anesthesia itself. Limitations and Perspectives This study has several limitations. Its retrospective design carries a risk of selection bias, although data collection was exhaustive and inclusion criteria ensured population homogeneity. The use of previously published standardisations (maternal hydration calculated in mL/kg or use of a reference for neonatal weight loss for a normal hydration) and the thresholds chosen (> 4 mL/kg over 4h and > 6 mL/kg over 6h) similar to those reported in other pediatric studies related to peripartum fluid management, ensured extrinsic comparisons with these previous studies [ 30 , 35 – 37 ]. The selected population of infant feed with a formula ensured a relative homogeneity of volume intake compared to breastfeeding variability within the first 48h of life [ 25 – 27 , 30 , 31 ], but no direct measurements of neonatal fluid balance (e.g. urine output and volume of formula intake) were available and limits further interpretation of the mechanisms underlying early postnatal weight loss. Nevertheless, these findings encourage cautious management of intrapartum fluid administration, particularly in cases of pharmacological induction. Further studies should focus on neonatal acceptable weight loss in regard to maternal fluid administration and early neonatal outcome (delayed discharge, jaundice…). Additionally, multivariate analysis would allow adjustment for potential unidentified confounders individualized acceptable neonatal weight loss. CONCLUSION This study identifies a significant association between maternal intrapartum intravenous fluid administration - particularly in the hours preceding delivery - and the extent of neonatal weight loss on the second day of life. These results suggest the existence of a transplacental fluid transfer, leading to fetal hemodilution and increased neonatal diuresis. Labor induction with oxytocin may act as a contributing factor, particularly through its association with increased fluid volumes. These findings support an optimisation of maternal hydration practices during the peripartum period, especially in cases involving induction or epidural analgesia. Prospective studies incorporating biological markers of neonatal hydration and direct measurement of urine output are needed to better characterize the underlying pathophysiological mechanisms. Considering maternal intravenous fluid management may help refine the interpretation of neonatal weight loss in the first days of life and inform clinical decision-making, particularly regarding the appropriateness of early discharge. Abbreviations BMI Body Mass Index SD Standard Deviation Declarations Competing Interests : The authors have no relevant financial or non-financial interests to disclose. Ethical approval : This observational study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of Amiens-Picardie University Hospital (registration number ID-RCB: 2208336). Consent to participate : Parental non-opposition was obtained prior to inclusion. Funding: The authors declare that no founds, grants or other support were received during the preparation of this manuscript. Author Contribution AM contributed to writing - original draft and conceptualization. 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07:43:50","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":101921,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8107573/v1/381c00f8b725e5b2e92f593f.html"},{"id":97119268,"identity":"73f1d2ea-e3f2-4f29-adbe-6914c394f196","added_by":"auto","created_at":"2025-12-01 07:43:49","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":269308,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNeonatal weight loss according to fluid volume administered in the 2 hours (a), 4 hours (b) and 6 hours (c) prepartum periods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eThe neonatal weight loss for a normal maternal hydration of 1-2 mL/kg was considered as reference (=1) to ensure comparisons over fluid administration categories and time.\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8107573/v1/acf328d2ff46bf75c128523a.png"},{"id":97141817,"identity":"521fac37-1788-4ef6-bc01-19284c860a52","added_by":"auto","created_at":"2025-12-01 10:07:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":119344,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNeonatal weight loss according to the labor\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8107573/v1/7e74e7207c78f0a9a6054691.png"},{"id":97119264,"identity":"aa14e278-0eca-4cbf-bd6e-52d9dbf922a0","added_by":"auto","created_at":"2025-12-01 07:43:49","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":228715,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNeonatal weight loss according to anesthesia type (a) and volume of fluid infusion by anesthesia type (b)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8107573/v1/9220e0adb668a9a337ec1780.png"},{"id":97119271,"identity":"3a0777b6-96f4-43e2-ae32-57a6d9c02147","added_by":"auto","created_at":"2025-12-01 07:43:50","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":17124,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNeonatal weight loss by mode of delivery\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8107573/v1/81ca2385ab4b54bd58a6a113.png"},{"id":97141596,"identity":"9be229ad-c3b6-4938-be76-b05de65ecf0d","added_by":"auto","created_at":"2025-12-01 10:06:50","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":310198,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCord blood hematocrit according to fluid volume administered in the 2 hours (a), 4 hours (b) and 6 hours (c) prepartum periods\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-8107573/v1/5ef66b59306e53099c7a961d.png"},{"id":99309943,"identity":"ce9b0a2e-0f0b-45d3-99ce-182d8cb2a6fc","added_by":"auto","created_at":"2025-12-31 16:11:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2107167,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8107573/v1/da2e21d5-b9d6-4676-945d-b68873ccc1f4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Maternal Prepartum Intravenous Fluid Administration is associated with Neonatal Weight Loss at day 2 of life","fulltext":[{"header":"What is Known","content":"\u003cp\u003eNeonatal weight loss in breastfed newborns is associated with lactation initiation success and maternal intrapartum fluid administration\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhat is New:\u0026nbsp;\u003c/strong\u003eIn formula-fed newborns, higher maternal fluid intake before delivery is significantly associated with greater neonatal weight loss and transient hemodilution, highlighting a direct hydric effect independent of feeding intake.\u003c/p\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eObstetric labor is a complex physiological and medical process involving a cascade of events ensuring a safe birth for both mother and child [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Common interventions during this period may include pelvic examinations [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], artificial rupture of membranes [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], administration of oxytocin [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], fetal monitoring [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and intravenous fluid administration. Maternal intravenous fluid loading is frequently used to prevent hypotension [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], improve placental perfusion, and support effective labor progression [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Severe or prolonged maternal hypotension may impair uteroplacental perfusion and lead to significant maternal and fetal complications [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, the neonatal consequences of maternal fluid administration - particularly potential transplacental water transfer resulting in a secondary early neonatal weight loss - remain insufficiently explored [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This early weight loss, typically occurring within the first 48 to 72 hours of life, is a well-described phenomenon [\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], influenced by factors such as gestational age, mode of delivery, time of birth, neonatal metabolic adaptation and certain maternal characteristics [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Nevertheless, excessive weight loss can lead to neonatal complications, including dehydration and hyperbilirubinemia, which may require specific medical intervention [\u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePrevious studies have investigated neonatal weight loss in the context of exclusive breastfeeding. Some have shown greater weight loss following cesarean delivery [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], or an association between the volume of intrapartum maternal fluids and neonatal diuresis [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, to our knowledge, the impact of prepartum maternal fluid administration on newborn fed with formula has not yet been studied. A better understanding of the impact of these obstetric practices could improve the clinical interpretation of early neonatal weight loss, guide appropriate monitoring, and improve the discharge plan from the maternity ward. These findings could also contribute to update of local guidelines regulating intrapartum intravenous fluid management.\u003c/p\u003e\u003cp\u003eThe primary objective of this study was to assess the effect of maternal intrapartum fluid administration on neonatal weight loss during the first 48 hours of life. Secondary objectives included exploring the association between maternal fluid intake and two other parameters correlated with neonatal hemodilution: Blood cord hematocrit and the occurrence of jaundice within the first 48 hours.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eThis was a monocentric, retrospective observational study conducted in the maternity ward of Amiens-Picardie University Hospital. The study protocol was approved by the Clinical Research Department of Amiens-Picardie University Hospital and registered by the Data Protection Officer (ID-RCB: 2208336). A written informed consent letter was delivered to all the mothers prior to inclusion.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003ePatients who delivered between September 1, 2024, and December 31, 2024, were eligible for inclusion. Inclusion criteria were:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eMaternal age\u0026thinsp;\u0026ge;\u0026thinsp;18 years;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEnrollment in a national health insurance system;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTerm delivery (\u0026ge;\u0026thinsp;37\u0026thinsp;+\u0026thinsp;0 weeks of gestation);\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSingleton pregnancy;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNewborn exclusively fed with infant formula during the first two days of life according to the unit protocol.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eNon-inclusion criteria were:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eRefusal to participate in the study;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMothers under legal guardianship;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eInability to understand French;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eRefusal to allow use of personal data for research purposes;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eExclusive or mixed breastfeeding;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMaternal fluid resuscitation due to hemodynamic instability within 12 hours prior to delivery;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNewborns with orofacial clefts, renal pathology, or congenital hydrops;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNeonatal death before 30 days of life;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIncomplete or inaccurately documented medical records.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was neonatal weight loss at 48 hours of life compared to the birth weight, expressed as a percentage: (Weight at 48h \u0026ndash; Birth weight) / Birth weight.\u003c/p\u003e\u003cp\u003eSecondary outcomes included:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eUmbilical cord hematocrit (%).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eIndependent variables assessed were:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eMaternal fluid administration: cumulative hourly fluid volumes (mL) (standard infusion line, oxytocin or other medications) in the 12 hours before delivery;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMaternal factors: age, gravidity, parity, weight, height, body mass index (BMI), gestational weight gain, relevant medical history (hypertension, diabetes, thyroid disorders), smoking status;\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eObstetric factors: fetal heart rate anomalies, mode of delivery (spontaneous vaginal, instrumental, scheduled or emergency cesarean), labor (spontaneous, balloon catheter, oxytocin, misoprostol), type of anesthesia (spinal, epidural, combined, or general);\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNeonatal factors: sex, Apgar scores at 1, 5, and 10 minutes.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eData were extracted from the electronic maternal and neonatal records (DxCare\u0026reg;, Dedalus) and the OBTRACEVUE\u0026reg; software (Philips\u0026reg;).\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eThe primary analysis aimed to investigate the association between neonatal weight loss at 48 hours and maternal fluid administration. Infused fluid volumes administered to the mother were normalized to maternal body weight (mL/kg) to define exposure subgroups. The mean neonatal weight loss at 48 hours for a maternal fluid administration of 1 to 2 mL/kg/h (normal hydration) was considered as a reference and thus compared to higher hydration groups for different time points (2h, 4h and 6h prior to delivery).\u003c/p\u003e\u003cp\u003eNormality of continuous variables was assessed using the Shapiro\u0026ndash;Wilk test. Variance homogeneity was evaluated both visually and using standard deviations. For normally distributed data, comparisons between two groups were made using Student\u0026rsquo;s t-test, and comparisons among more than two groups were performed using one-way ANOVA. If significant, post hoc analysis was conducted with Tukey\u0026rsquo;s test. For non-parametric data, the Kruskal\u0026ndash;Wallis test was used. Results are reported as means\u0026thinsp;\u0026plusmn;\u0026thinsp;SEM for continuous variables. A two-sided p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003ePopulation Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 200 mother-infant dyads were included. The mean maternal age was 28.8 \u0026plusmn; 4.3 years. The mean maternal weight at the end of pregnancy was 82.9 \u0026plusmn; 14.1 kg, with an average gestational weight gain of 11.5 \u0026plusmn; 5.1 kg. The mean gravidity was 2.65 \u0026plusmn; 1.42, and the mean parity was 2.06 \u0026plusmn; 0.89. The average duration of prepartum intravenous fluid administration was 5.64 \u0026plusmn; 3.79 hours. Mean fluid volumes administered were 173.4 \u0026plusmn; 75.5 mL in the 2 hours, 309.9 \u0026plusmn; 161.8 mL in the 4 hours, and 410.0 \u0026plusmn; 249.8 mL in the 6 hours preceding delivery. Labor was mainly spontaneous (n = 134/200) (Table1). Epidural analgesia was administered in 79% of women (n = 158).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe mean birth weight was 3295 \u0026plusmn; 359 g and 3157 \u0026plusmn; 346 g on day 2 of life (-4.16% \u0026plusmn; 1.73%). Newborn infants were female in 46% (n = 92). Most deliveries occurred via vaginal route (75.5%) (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Maternal, obstetric and neonatal characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"643\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin - Max\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMother\u0026rsquo;s age (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e28.8 \u0026plusmn; 4.3 \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e18 \u0026ndash; 42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMother\u0026rsquo;s height (m)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1.65 \u0026plusmn; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1.49 \u0026ndash; 1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMother\u0026rsquo;s weight closest to delivery (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e82.85 \u0026plusmn; 14.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e49 \u0026ndash; 139\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight gain during pregnancy (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e11.5 \u0026plusmn; 5.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e-13 \u0026ndash; 28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e30.43 \u0026plusmn; 4.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e18.02 \u0026ndash; 50.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;3\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026gt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2.65 \u0026plusmn; 1.42\u003c/p\u003e\n \u003cp\u003e65 (32,5%)\u003c/p\u003e\n \u003cp\u003e54 (27%)\u003c/p\u003e\n \u003cp\u003e32 (16%)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22 (11%)\u003c/p\u003e\n \u003cp\u003e27 (13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1 \u0026ndash; 13\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;3\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026gt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2.06 \u0026plusmn; 0.89\u003c/p\u003e\n \u003cp\u003e81 (40.5%) \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e67 (33.5%)\u003c/p\u003e\n \u003cp\u003e26 (13%)\u003c/p\u003e\n \u003cp\u003e13 (6.5%)\u003c/p\u003e\n \u003cp\u003e12 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1 \u0026ndash; 6\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking during pregnancy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eYes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48 (24%)\u003c/p\u003e\n \u003cp\u003e152 (76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of high blood pressure\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eYes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (2%)\u003c/p\u003e\n \u003cp\u003e196 (98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of diabetes\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (1.5%)\u003c/p\u003e\n \u003cp\u003e197 (98.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational diabetes\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27 (13.5%)\u003c/p\u003e\n \u003cp\u003e173 (86.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal intrapartum fluid administration\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Duration (h)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Volume at H2 (mL)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Volume at H4 (mL)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Volume at H6 (mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.64 \u0026plusmn; 3.79\u003c/p\u003e\n \u003cp\u003e173.39 \u0026plusmn; 75.46\u003c/p\u003e\n \u003cp\u003e309.93 \u0026plusmn; 161.8\u003c/p\u003e\n \u003cp\u003e410.03 \u0026plusmn; 249.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 \u0026ndash; 32.52\u003c/p\u003e\n \u003cp\u003e0 \u0026ndash; 470\u003c/p\u003e\n \u003cp\u003e0 \u0026ndash; 900\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 - 1330\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnesthesia\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNone\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Epidural\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Spinal anesthesia\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; General anesthesia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23 (11.5%)\u003c/p\u003e\n \u003cp\u003e158 (79%)\u003c/p\u003e\n \u003cp\u003e20 (10%)\u003c/p\u003e\n \u003cp\u003e1 (0.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInduction of labor\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Pharmacological\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Oxytocin\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Misoprostol\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Non-pharmacological\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Intracervical balloon\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Spontaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56/200\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 17/200\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 39/200\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e144/200\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;10/200\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;134/200\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMethod of delivery\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Vaginal delivery\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Cesarean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e151 (75.5%)\u003c/p\u003e\n \u003cp\u003e49 (24.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNewborn sex\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e92 (46%)\u003c/p\u003e\n \u003cp\u003e108 (54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHematocrit (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e51.57 \u0026plusmn; 3.96\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e17.90 \u0026ndash; 64.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBirth weight (g)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e3295.20 \u0026plusmn; 359.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2140 \u0026ndash; 4700\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight at two days old (g)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e3157.46 \u0026plusmn; 346.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2060 \u0026ndash; 4570\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeonatal jaundice\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eYes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14 (7%)\u003c/p\u003e\n \u003cp\u003e186 (93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eFluid Volume and Neonatal Weight Loss\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo significant association was observed between the fluid volume administered to the mother in the 2 hours before delivery and the neonatal weight loss (-3.58%, -3.80% and -4.18% for 1-2 mL/kg, 2-4 mL/kg and \u0026gt;4mL/kg conditions respectively) (Fig1a). However, the neonatal weight loss was significantly greater when the fluid volume administered to the mother exceeded 4 mL/kg over the 4 hours prior to the delivery (p = 0.0168) (Fig1b), and 6 mL/kg over the last 6 hours (p = 0.027) (Fig1c).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEffect of Labor Induction Method on neonatal weight loss\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNewborn infants from mothers who received intravenous oxytocin had a significantly greater weight loss on day 2 compared to those whose mother had non-pharmacological labor induction (spontaneous or balloon catheter) \u0026nbsp; \u0026nbsp;(p = 0.036) (Fig2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEffect of maternal anesthesia Type\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe type of maternal anesthesia (epidural, spinal, or no anesthesia) was not significantly associated with neonatal weight loss on day 2 (Fig3a). However, the volume of fluids administered in the six hours before delivery was significantly higher in patients who received epidural analgesia (p \u0026lt; 0.05) (Fig3b).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEffect of the Mode of Delivery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mode of delivery (vaginal or cesarean) was not significantly associated with neonatal weight loss on day 2 (Fig4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInfluence of Other Maternal Factors on neonatal weight loss\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo significant association was found between neonatal weight loss on day 2 and maternal age, BMI, gestational weight gain, gravidity or parity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUmbilical Cord Hematocrit\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA fluid volume administration \u0026gt; 2 mL/kg in the two hours preceding the delivery was significantly associated with a lower umbilical cord blood hematocrit (p \u0026lt; 0.05) (Fig5a). No significant difference was observed for fluid volume administrations over the 4-hour or 6-hour periods (Fig5b and Fig5c).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study highlights a significant association between maternal intrapartum intravenous fluid administration and neonatal weight loss on the second day of life. This relationship appears to be dose-dependent, with a threshold effect observed from 4 mL/kg over 4 hours and 6 mL/kg over 6 hours. No significant association was found for fluid volumes infused in the last 2 hours before delivery. These findings suggest a possible influence of maternal fluid balance on early neonatal hydration, independent of the mode of delivery.\u003c/p\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003ePopulation Characteristics\u003c/h2\u003e\u003cp\u003eThe average birth weight observed was consistent with previously published data, generally around 3300 g [\u003cspan additionalcitationids=\"CR26 CR27 CR28\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This homogeneous cohort, which excluded breastfeeding, allowed better isolation of the effect of maternal fluid administration compared to a variable feeding volume intake for the breastfeeding infants. Maternal characteristics (age, BMI, gravidity, parity) were not significantly associated with neonatal weight loss, supporting the hypothesis of a direct effect of intrapartum hydration.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eImpact of Maternal Fluid Administration on Neonatal Weight Loss\u003c/h2\u003e\u003cp\u003eThe observed correlation between maternal intravenous fluid administration and neonatal weight loss aligns with known pathophysiological mechanisms. The mean weight loss in our cohort (-4.16% \u0026plusmn; 1.73%) was slightly below the classical thresholds reported for exclusively breastfed infants (5\u0026ndash;7%) [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], but close to previous data focusing on formula fed newborn infants [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSeveral authors have proposed that maternal fluid infusion may result in a transplacental water transfer, transiently increasing fetal hydration [\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This fluid overload at birth may then be followed by rapid postnatal diuresis, accounting for the increased weight loss [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn addition, we observed that these higher volumes were significantly associated with a decrease in umbilical cord hematocrit, reinforcing the hypothesis of neonatal hemodilution secondary to maternal overhydration [\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This objective biological marker provides additional evidence in support of a direct physiological link.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eInfluence of Obstetric Practices: Induction and Anesthesia\u003c/h2\u003e\u003cp\u003eWeight loss was significantly greater in neonates born following induction with intravenous oxytocin compared to non-pharmacological induction. This may be due to more frequent use of intravenous fluids during pharmacological labor induction. This potential confounding factor underlines the interaction between obstetric practices and maternal fluid balance. In contrast, the mode of delivery (vaginal or cesarean) was not significantly associated with neonatal weight loss.\u003c/p\u003e\u003cp\u003eEpidural anesthesia was associated with significantly higher volumes of intravenous fluids, in line with anesthesic recommendations to prevent maternal hypotension [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. However, no direct association was found between the type of anesthesia and weight loss on day 2, suggesting that the observed effect is likely mediated by the total fluid administered volume rather than the anesthesia itself.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eLimitations and Perspectives\u003c/h2\u003e\u003cp\u003eThis study has several limitations. Its retrospective design carries a risk of selection bias, although data collection was exhaustive and inclusion criteria ensured population homogeneity. The use of previously published standardisations (maternal hydration calculated in mL/kg or use of a reference for neonatal weight loss for a normal hydration) and the thresholds chosen (\u0026gt;\u0026thinsp;4 mL/kg over 4h and \u0026gt;\u0026thinsp;6 mL/kg over 6h) similar to those reported in other pediatric studies related to peripartum fluid management, ensured extrinsic comparisons with these previous studies [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The selected population of infant feed with a formula ensured a relative homogeneity of volume intake compared to breastfeeding variability within the first 48h of life [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], but no direct measurements of neonatal fluid balance (e.g. urine output and volume of formula intake) were available and limits further interpretation of the mechanisms underlying early postnatal weight loss.\u003c/p\u003e\u003cp\u003eNevertheless, these findings encourage cautious management of intrapartum fluid administration, particularly in cases of pharmacological induction. Further studies should focus on neonatal acceptable weight loss in regard to maternal fluid administration and early neonatal outcome (delayed discharge, jaundice\u0026hellip;). Additionally, multivariate analysis would allow adjustment for potential unidentified confounders individualized acceptable neonatal weight loss.\u003c/p\u003e\u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study identifies a significant association between maternal intrapartum intravenous fluid administration - particularly in the hours preceding delivery - and the extent of neonatal weight loss on the second day of life. These results suggest the existence of a transplacental fluid transfer, leading to fetal hemodilution and increased neonatal diuresis. Labor induction with oxytocin may act as a contributing factor, particularly through its association with increased fluid volumes. These findings support an optimisation of maternal hydration practices during the peripartum period, especially in cases involving induction or epidural analgesia. Prospective studies incorporating biological markers of neonatal hydration and direct measurement of urine output are needed to better characterize the underlying pathophysiological mechanisms.\u003c/p\u003e\u003cp\u003eConsidering maternal intravenous fluid management may help refine the interpretation of neonatal weight loss in the first days of life and inform clinical decision-making, particularly regarding the appropriateness of early discharge.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBody Mass Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard Deviation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cb\u003eCompeting Interests\u003c/b\u003e:\u003c/h2\u003e\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003e\u003cb\u003eEthical approval\u003c/b\u003e:\u003c/h2\u003e\u003cp\u003e This observational study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of Amiens-Picardie University Hospital (registration number ID-RCB: 2208336).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cb\u003eConsent to participate\u003c/b\u003e:\u003c/strong\u003e\u003cp\u003eParental non-opposition was obtained prior to inclusion.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eThe authors declare that no founds, grants or other support were received during the preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAM contributed to writing - original draft and conceptualization. CM contributed to project administration, methodology and data curation. AM, CM and PT contributed to investigation, writing - review and editing, supervision.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eEnquiries about data availability should be directed to the authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRosen H, Yogev Y (2023) Assessment of uterine contractions in labor and delivery. Am J Obstet Gynecol 228:S1209\u0026ndash;S1221. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ajog.2022.09.003\u003c/span\u003e\u003cspan address=\"10.1016/j.ajog.2022.09.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYulia A, Johnson MR (2014) Myometrial oxytocin receptor expression and intracellular pathways. 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LRA 143\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Newborn, infant, delivery, birthweight, Diuresis","lastPublishedDoi":"10.21203/rs.3.rs-8107573/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8107573/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMaternal intravenous fluid administration during labor is widely used for treatment administration and to ensure adequate uteroplacental perfusion. Its potential effects on neonatal outcomes, particularly early weight loss, are not fully understood, with data mainly derived from breastfed infants. Evidence in formula-fed infants remains lacking. We aimed to evaluate the impact of prepartum maternal fluid administration on 48-hour weight loss in exclusively formula-fed newborns. Blood cord haematocrit was also studied as a reflect of neonatal potential blood dilution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective, observational study was conducted at Amiens-Picardie University Hospital between September and December 2024. Term singleton infants exclusively formula-fed during the first two days of life were included. Maternal intravenous fluid volumes during the 12 hours preceding delivery were recorded. Primary outcome was neonatal weight loss at day 2. The secondary outcome was blood cord hematocrit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong 200 mother-infant dyads, maternal fluid loading \u0026gt; 4 mL/kg in the 4–6 hours before delivery was significantly associated with greater neonatal weight loss at 48 hours (p = 0.0168 and p = 0.027, respectively). Oxytocin exposure was also associated with an increased weight loss (p = 0.036). Higher fluid intake \u0026gt; 2 mL/kg in the 2 hours before delivery correlated with lower cord haematocrit (p = 0.024).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA higher maternal intrapartum fluid administration was associated with an increased neonatal weight loss and a lower blood cord hematocrit in formula-fed infants. These findings support the hypothesis of transient neonatal fluid overload followed by diuresis, and underline the need to account for maternal fluid balance when interpreting early neonatal weight changes.\u003c/p\u003e","manuscriptTitle":"Maternal Prepartum Intravenous Fluid Administration is associated with Neonatal Weight Loss at day 2 of life","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-01 07:43:45","doi":"10.21203/rs.3.rs-8107573/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0035f3ea-bff1-461a-9ee7-263a8df0cca5","owner":[],"postedDate":"December 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-23T20:38:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-01 07:43:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8107573","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8107573","identity":"rs-8107573","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}