Hounkonnou C. P. A. auteur aut IRD Tuikue Ndam Nicaise auteur aut IRD Fievet Nadine auteur aut IRD Accrombessi M. auteur aut IRD Yovo E. auteur aut IRD Mama A. auteur aut IRD Sossou D. auteur aut IRD Vianou B. auteur aut IRD Massougbodji A. auteur aut IRD Briand Valérie auteur aut IRD Cot Michel auteur aut IRD Cottrell Gilles auteur aut IRD text journalArticle eng text/pdf reformatted digital access Background. Harmful maternal and neonatal health outcomes result from malaria in pregnancy, the prevention of which primarily relies on intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP). The World Health Organization recommends IPTp-SP in sub-Saharan Africa, but implementation is highly heterogeneous and often suboptimal in terms of the number of doses and their timing. In this study, we assessed the impact of this heterogeneity on malaria in pregnancy, mainly with respect to submicroscopic Plasmodium falciparum infections. Methods. We used data from 273 Beninese women followed throughout pregnancy. Screening for P. falciparum infections, using both microscopy-based and polymerase chain reaction (PCR)-based methods, was performed monthly, and information on IPTp-SP doses was collected. Gestational age was estimated by repeated ultrasound scans. Using a negative binomial model, we investigated the effect of IPTp-SP doses and timing after 17 weeks of gestation on the number of P. falciparum infections, focusing on submicroscopic infections detectable only by PCR. Results. At least 2 IPTp-SP doses were taken by 77.3% of the women. The median gestational age at the first IPTp-SP dose was 22 weeks. A late first IPTp-SP dose (>21.2 weeks) was marginally associated with an increased number of P. falciparum infections (adjusted incidence rate ratio [aIRR] = 1.3; P = .098). The number of IPTp-SP doses was not associated with the number of submicroscopic infections (aIRR = 1.2, P = .543). Conclusions. A late first IPTp-SP dose failed to provide optimal protection against P. falciparum, especially submicroscopic infections. This highlights the need for a new antimalarial drug for IPTp that could be taken early in pregnancy. specialized submicroscopic P. falciparum infection pregnancy intermittent preventive treatment prospective cohort sub-Saharan Africa BENIN 050 052 73 11 E3759-E3767 [9 ] 2021 1058-4838 https://www.documentation.ird.fr/hor/fdi:010083900 10.1093/cid/ciaa1355 1058-4838 [F B010083900] https://www.documentation.ird.fr/hor/fdi:010083900 https://horizon.documentation.ird.fr/exl-doc/pleins_textes/2022-02/010083900.pdf IRD - Base Horizon / Pleins textes 2022-02-04 2025-02-24 fdi:010083900 fre