{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:54:15Z","timestamp":1791899655588,"version":"4.3.4"},"reference-count":37,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T00:00:00Z","timestamp":1623888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["ascpt.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Pharma and Therapeutics"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:p>Intermittent preventive treatment in pregnancy with sulfadoxine\u2010pyrimethamine (IPTp\u2010SP) to prevent malaria and adverse birth outcomes is threatened by <jats:italic>Plasmodium falciparum<\/jats:italic> resistance to sulfadoxine\u2010pyrimethamine. We investigated the effectiveness of intermittent preventive treatment in pregnancy with monthly dihydroartemisinin\u2010piperaquine (IPTp\u2010DHP) as an alternative option to IPTp\u2010SP. A total of 956 malaria\u2010free (malaria rapid diagnostic test (MRDT) negative) pregnant women from moderate malaria transmission areas in Tanzania were enrolled and randomized to receive monthly IPTp\u2010DHP (<jats:italic>n<\/jats:italic>\u00a0=\u00a0478) or IPTp\u2010SP (<jats:italic>n<\/jats:italic>\u00a0=\u00a0478) and followed for maternal and birth outcomes. The primary outcome was the prevalence of histopathologically confirmed placental malaria (active or past infection). Secondary outcomes were overall malaria at delivery, symptomatic\u2010malaria, parasitemia during pregnancy, and adverse birth outcomes as a composite of spontaneous\u2010abortion, premature birth, stillbirth, and low birth weight (LBW) fetal anemia. Outcome differences between treatment groups were expressed as the protective efficacy (PE), defined as 1\u2010prevalence ratios or 1\u2010incidence rate ratio. The prevalence of histopathologically confirmed placental malaria was significantly lower in IPTp\u2010DHP (2.5%, 12\/478) than IPTp\u2010SP (8.2%, 39\/478); PE\u00a0=\u00a069% (95% confidence interval (CI): 42\u201384, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). The prevalence of maternal malaria at delivery was significantly lower in IPTp\u2010DHP (8.2%) than IPTp\u2010SP (18.2%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). The incidence per person\u2010years at risk for symptomatic\u2010malaria (0.02 vs. 0.12, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.002) and parasitemia during pregnancy (0.28 vs. 0.67, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) were significantly lower in the IPTp\u2010DHP group than in the IPTp\u2010SP group. The prevalence of any adverse birth outcomes (composite) was not significantly (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.06) different between IPTp\u2010DHP (17.9%) and IPTp\u2010SP (23.8%). However, the prevalence of LBW (4.6% vs. 9.6%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.003) was significantly lower in IPTp\u2010DHP compared with IPTp\u2010SP. We report superior protective efficacy of monthly IPTp\u2010DHP against malaria in pregnancy and LBW than IPTp\u2010SP.<\/jats:p>","DOI":"10.1002\/cpt.2273","type":"journal-article","created":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T19:32:13Z","timestamp":1619206333000},"page":"1478-1489","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Effectiveness of Intermittent Preventive Treatment With Dihydroartemisinin\u2010Piperaqunine Against Malaria in Pregnancy in Tanzania: A Randomized Controlled Trial"],"prefix":"10.1111","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5764-3424","authenticated-orcid":false,"given":"Eulambius M.","family":"Mlugu","sequence":"first","affiliation":[{"name":"Division of Clinical Pharmacology Department of Laboratory Medicine Karolinska Institutet at Karolinska University Hospital Stockholm Sweden"},{"name":"Department of Pharmaceutics and Pharmacy Practice School of Pharmacy Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8692-1924","authenticated-orcid":false,"given":"Omary","family":"Minzi","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy and Pharmacology School of Pharmacy Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6895-9187","authenticated-orcid":false,"given":"Appolinary A. R.","family":"Kamuhabwa","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy and Pharmacology School of Pharmacy Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9788-0790","authenticated-orcid":false,"given":"Eleni","family":"Aklillu","sequence":"additional","affiliation":[{"name":"Division of Clinical Pharmacology Department of Laboratory Medicine Karolinska Institutet at Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,6,17]]},"reference":[{"key":"e_1_2_11_1_1","unstructured":"World Health organization.World Malaria report 2019<https:\/\/www.who.int\/publications\u2010detail\/world\u2010malaria\u2010report\u20102019>. 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Accessed November 7 2020."},{"key":"e_1_2_11_37_1","unstructured":"World Health Organization.Malaria Policy Advisory Committee Meeting: The cardiotoxicity of antimalarials<https:\/\/www.who.int\/malaria\/mpac\/mpac\u2010mar2017\u2010erg\u2010cardiotoxicity\u2010report\u2010session2.pdf>. 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