What type of study is this?

This is a Meta-Analysis study (also classified as: Systematic Review).

What question did this study set out to answer?

To assess the effectiveness of dihydroartemisinin-piperaquine compared to sulfadoxine-pyrimethamine in preventing adverse pregnancy outcomes related to malaria.

January 14, 2026Open Forum Infectious Diseases0 citationsOpen Access

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Comparative Effectiveness of Dihydroartemisinin-Piperaquine and Sulfadoxine-Pyrimethamine in Preventing Adverse Pregnancy Outcomes: A Meta-Analysis and Systematic Review

JBJose Luis BoeneEduardo Mondlane University SCSophia CostaFundação Hospitalar do Estado de Minas Gerais OROscar Hernández RiosUniversidad Ricardo Palma

Key Points

To assess the effectiveness of dihydroartemisinin-piperaquine compared to sulfadoxine-pyrimethamine in preventing adverse pregnancy outcomes related to malaria.
Conducted a systematic review and meta-analysis of randomized controlled trials
Compared IPTp-DHA-PQ and IPTp-SP for outcomes like placental malaria and LBW
Pooled data using random-effects meta-analysis with odds ratios and confidence intervals
Assessed risk of bias and evaluated heterogeneity using the I² statistic
DHA-PQ significantly reduced placental malaria incidence compared to SP (OR: 0.51)
No significant differences in LBW, PTB, fetal loss, or neonatal deaths between the two regimens
Both treatments were well-tolerated with minimal adverse effects reported

Abstract

Abstract Background Malaria in pregnancy remains a significant public health challenge, particularly in sub-Saharan Africa (SSA), where it contributes to maternal anemia, low birthweight (LBW), preterm birth (PTB), and neonatal mortality. With increasing resistance to sulfadoxine-pyrimethamine (SP), the World Health Organization (WHO)-recommended intermittent preventive treatment during pregnancy (IPTp) strategy faces declining efficacy. Dihydroartemisinin-piperaquine (DHA-PQ) has emerged as a promising alternative, but its impact on broader perinatal outcomes remains unclear.Placental malária (microscopy, RDT, LAMP, PCR)Low Birth Weight Methods A systematic search of PubMed, EMBASE, Cochrane Library, and LILACS was conducted to identify randomized controlled trials (RCTs) comparing IPTp-DHA-PQ to IPTp-SP. Outcomes included placental malaria, Low birth weight ( 2500 g), fetal loss (still birth and spontaneous abortion), Pre Term Birth ( 37 weeks), neonatal death (0–28 days), and fetal anemia (Hb 11 g/dL) . Data were pooled using a random-effects meta-analysis, with odds ratios (OR) and 95% confidence intervals (CI) reported. Risk of bias was assessed using Cochrane methods, and heterogeneity was evaluated using the I² statistic.Fetal loss (still birth and spontaneous abortation)Neonatal Deaths Results Seven RCTs involving 8,080 participants were included. DHA-PQ significantly reduced the incidence of placental malaria compared to SP (OR: 0.51, 95% CI: 0.30–0.87), demonstrating superior efficacy against malaria-specific endpoints. However, no significant differences were observed between DHA-PQ and SP for LBW, PTB, fetal loss, or neonatal deaths. Both regimens were well-tolerated, with minimal adverse effects reported. Conclusion DHA-PQ effectively prevents placental malaria, particularly in regions with high SP resistance, while showing comparable outcomes to SP for broader pregnancy complications. These findings support its use as an alternative to SP and highlight the need for integration into holistic antenatal care strategies to improve pregnancy outcomes in malaria-endemic regions, informing potential updates to WHO guidelines. Disclosures All Authors: No reported disclosures

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Cite This Study

Boene et al. (Thu,) studied this question.

synapsesocial.com/papers/6966e70113bf7a6f02bff148 https://doi.org/https://doi.org/10.1093/ofid/ofaf695.155

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