Design: Double-blind randomised trial, infant follow-up
Population: 871 Ugandan infants of mothers given monthly SP, DP or DP plus SP
Primary outcome: Clinical malaria incidence to 12 months
Effect: IRR 1.04 (95% CI 0.78-1.38) DP vs SP; 0.93 (0.68-1.26) DP plus SP vs SP

Dihydroartemisinin-piperaquine (DP) prevents more malaria in pregnancy than sulfadoxine-pyrimethamine (SP), but earlier trials linked it to lower birth weights. This double-blind Ugandan trial followed 871 infants born to mothers randomised to monthly SP, DP or DP plus SP, through to 12 months.

There were 667 episodes of clinical malaria. Infant malaria incidence was similar with DP (IRR 1.04, 95% CI 0.78-1.38) and DP plus SP (IRR 0.93, 0.68-1.26) compared with SP. About a fifth of monthly visits found parasites, with no difference between groups.

Wasting at birth was about twice as common after DP (PR 2.25, 1.03-4.94) or DP plus SP (PR 2.30, 1.07-4.97), but the difference resolved by 3-6 months.

For clinicians in high-transmission settings, this is modest reassurance that the maternal benefit of DP does not come at a lasting infant cost. It is one trial in one setting, and it does not settle which regimen national programmes should use.

Infant malaria to 12 months was similar whether mothers received SP, DP or both.
Wasting at birth was about twice as common after DP-containing regimens.
That wasting difference had gone by 3-6 months of age.
Follow your national malaria programme's IPTp regimen; this trial does not replace it.
Plot growth at early infant visits when a mother received DP in pregnancy.

Why it matters

It eases the main worry about switching to a more effective maternal regimen — that infants pay for it later.

The statistics, in plain English

An incidence rate ratio near 1 with an interval spanning both sides of 1 means no detectable difference in infant malaria. The wasting estimates have wide intervals that only just exclude 1, so the size of that effect is uncertain.