Towards Intermittent Preventive Therapy in Pregnancy with Dihydroartemisinin-Piperaquine?

Introduction: Malaria is a major cause of adverse pregnancy outcomes in sub-Saharan Africa, but resistance to sulfadoxine-pyrimethamine (SP), the only antimalarial recommended by the World Health Organisation for intermittent preventive therapy, is threatening the gains made in the last 2 decades. In this issue, Mlugu and colleagues present the results of a trial of dihydroartemisinin- -piperaquine as an alternative to SP. The results are impressive, showing a 69% reduction in placental malaria and a 59% reduction in adverse pregnancy outcomes, but raise the question why they differ so much from three previously published trials.

Automated summary

Malaria is a major cause of adverse pregnancy outcomes in sub-Saharan Africa and resistance to the recommended antimalarial, sulfadoxine-pyrimethamine, is threatening progress. A trial of dihydroartemisinin-piperaquine as an alternative to sulfadoxine-pyrimethamine showed significant reductions in placental malaria and adverse pregnancy outcomes. The results raise questions about the discrepancies with previous trials.