| Final | 19:38 | time |   | gap | L |  | 1. |   United States | 3:53.78 |   |   | 1 | 1. |  |  |  Regan Smith 58.40s, Lilly King 1:05.89, Torri Huske 56.67s, Claire Curzan 52.82s |  | 2. |   Australia | 3:54.25 |   |   | 4 | 2. |  |  |  Kaylee McKeown 58.77s, Jenna Strauch 1:05.99, Brianna Throssell 57.19s, Mollie O'Callaghan 52.30s |  | 3. |   Canada | 3:55.01 |   |   | 6 | 3. |  |  |  Kylie Masse 58.39s, Rachel Nicol 1:07.17, Maggie Mac Neil 56.80s, Penny Oleksiak 52.65s |  | 4. |   Sweden | 3:55.96 |   |   | 3 | 4. |  |  |  Hanna Rosvall 1:00.72, Sophie Hansson 1:06.20, Louise Hansson 56.38s, Sarah Sjöström 52.66s |  | 5. |   Netherlands | 3:57.24 |   |   | 5 | 5. |  |  |  Kira Toussaint 59.80s, Tes Schouten 1:06.60, Maaike de Waard 57.39s, Marrit Steenbergen 53.45s |  | 6. |   China | 3:57.73 |   |   | 7 | 6. |  |  |  Peng Xuwei 59.96s, Tang Qianting 1:06.62, Zhang Yufei 57.64s, Yang Junxuan 53.51s |  | 7. |   Italy | 3:58.86 |   |   | 2 | 7. |  |  |  Margherita Panziera 1:00.35, Benedetta Pilato 1:07.00, Elena Di Liddo 57.45s, Silvia Di Pietro 54.06s |  | 8. |   France | 3:59.94 |   |   | 8 | 8. |  |  |  Emma Terebo 1:00.58, Adèle Blanchetière 1:08.34, Marie Wattel 57.79s, Charlotte Bonnet 53.23s |   
|  59 Competitors from 12 Nations. |  | World and Championship Record: United States 3:50.40 Gwangju, South Korea 28 July 2019 |   
|
 Heats - Saturday, 25th June 09:39 |  | Best 8 times advanced to Final.  |   
| Heat 2 |   | time |   | gap | L | Rk. |  | 1. |   Australia | 3:56.77 | Q |   | 4 | 1. |  |  |  Kaylee McKeown 59.06s, Jenna Strauch 1:07.79, Brianna Throssell 57.29s, Madison Wilson 52.63s |  | 2. |   Canada | 3:58.38 | Q |   | 5 | 4. |  |  |  Ingrid Wilm 59.54s, Kelsey Wog 1:08.26, Maggie Mac Neil 57.23s, Kayla Sanchez 53.35s |  | 3. |   Italy | 3:59.40 | Q |   | 6 | 5. |  |  |  Silvia Scalia 1:01.12, Arianna Castiglioni 1:06.29, Elena Di Liddo 57.79s, Silvia Di Pietro 54.20s |  | 4. |   China | 3:59.55 | Q |   | 3 | 6. |  |  |  Peng Xuwei 1:00.29, Yu Jingyao 1:07.70, Zhang Yufei 57.47s, Yang Junxuan 54.09s |  | 5. |   France | 4:01.45 | Q |   | 2 | 8. |  |  |  Emma Terebo 1:00.77, Adèle Blanchetière 1:08.99, Marie Wattel 57.83s, Charlotte Bonnet 53.86s |  | 6. |   Israel | 4:03.28 |   |   | 1 | 9. |  |  |  Aviv Barzelay 1:01.65, Anastasia Gorbenko 1:07.02, Lea Polonsky 59.42s, Daria Golovaty 55.19s |  | -. |   South Korea | 4:05.29 |   |   | 7 | 11. |  |  |  Lee Eun-ji 1:00.79, Moon Su-a 1:09.56, Jeong So-eun 59.49s, Hur Yeon-kyung 55.45s |   
| Heat 1 |   | time |   | gap | L | Rk. |  | 1. |   Netherlands | 3:57.48 | Q |   | 6 | 2. |  |  |  Kira Toussaint 59.75s, Tes Schouten 1:06.83, Maaike de Waard 57.45s, Marrit Steenbergen 53.45s |  | 2. |   Sweden | 3:57.81 | Q |   | 3 | 3. |  |  |  Hanna Rosvall 1:01.05, Sophie Hansson 1:06.94, Louise Hansson 56.71s, Sarah Sjöström 53.11s |  | 3. |   United States | 4:00.06 | Q |   | 4 | 7. |  |  |  Rhyan White 1:00.12, Alexandra Walsh 1:07.60, Natalie Hinds 58.88s, Erika Brown 53.46s |  | 4. |   Brazil | 4:04.59 |   |   | 2 | 10. |  |  |  Stephanie Balduccini 1:03.43, Jhennifer Conceição 1:07.30, Giovanna Diamante 58.37s, Ana Carolina Vieira 55.49s |  | -. |   Great Britain | DSQ |   |   | 5 | -. |  |  |  Medi Harris 1:00.37, Molly Renshaw, Laura Stephens, Lucy Hope |  | . |   Thailand | DNS |   |   | 1 | -. |  |  |    |  | -. |   Greece | DNS |   |   | 7 | -. |  |  |    |   
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