Impact of Intermittent Preventive Treatment for Malaria in Pregnancy With Sulfadoxine-Pyrimethamine, Dihydroartemisinin-Piperaquine, and Their Combination on Infant Outcomes: A Randomized Controlled Trial.
Joaniter I Nankabirwa, Abel Kakuru, Anna T Nguyen et al.
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In 30 seconds
This double-blind randomized controlled trial compared infant malaria and growth outcomes after maternal intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (SP), dihydroartemisinin-piperaquine (DP), or both. Among 871 infants followed to 12 months, clinical malaria incidence was similar after maternal DP or DP plus SP versus SP alone: incidence rate ratios were 1.04 (95% CI .78-1.38) and 0.93 (95% CI .68-1.26), respectively. Parasite prevalence was also similar. Wasting was more prevalent at birth after DP-containing regimens, but group differences had resolved by 3-6 months.
Key findings
- Among 871 infants, 667 clinical malaria episodes occurred; incidence was similar after maternal DP or DP plus SP versus SP (IRR 1.04, 95% CI .78-1.38; IRR = 0.93, 95% CI .68-1.26).
- Overall parasite prevalence at monthly visits was 21.8%, with similar prevalence across the three maternal treatment groups.
- Wasting at birth was more prevalent after maternal DP plus SP (PR = 2.30, 95% CI 1.07-4.97) or DP (PR = 2.25, 95% CI 1.03-4.94) than after SP; differences resolved by 3-6 months.
Why it matters
The trial assesses whether differences in malaria prevention during pregnancy translate into infant outcomes after birth. Infant malaria incidence and parasite prevalence did not differ detectably across the three regimens, while the higher prevalence of wasting at birth after DP-containing regimens was transient. These findings help frame the balance of maternal preventive regimens in relation to infant health, without establishing broader effects beyond the outcomes studied.
What to keep in mind
Infants were followed only to 12 months, so the trial does not establish longer-term outcomes.