Practical Info Malaria infection during pregnancy is a major public health problem, with substantial risks for the mother, her fetus and the newborn. WHO recommends a package of interventions for preventing and controlling malaria during pregnancy, which includes promotion and use of insecticide-treated nets, indoor residual spraying, appropriate case management with prompt, effective treatment and, in areas with moderate to high transmission of P. falciparum, administration of IPTpSP. In the systematic review (81), the reduction in risk for low birth weight was consistent for a wide range of levels of resistance to SP. The group that received three or more doses also had less placental malaria. There were no differences in serious adverse events between the two groups. On the basis of these results, WHO now encourages that, in areas of moderate-to-high malaria transmission of Africa, IPTp-SP be given to all pregnant women at each scheduled antenatal care visit, starting as early as possible in the second trimester, provided that the doses of SP are given at least 1 month apart. The objective is to ensure that at least three doses are received. In several countries in Africa, some P. falciparum parasites carry quintuple mutations (triple Pfdhfr and double Pfdhps), which are associated with therapeutic failure of SP treatment. IPTp-SP remains effective in preventing the adverse consequences of malaria on maternal and fetal outcomes in areas where a high proportion (> 90%) of P. falciparum parasites carry these quintuple mutations. Therefore, IPTp-SP should still be administered to women in these areas. In areas where P. falciparum carrying six mutations (either Pfdhfr 164 or Pfdhps 581) are prevalent, the efficacy of IPTp-SP may be compromised. It is unclear by how much. There are currently insufficient data to define the level of P. falciparum transmission at which IPTp-SP may cease to be cost-effective from a public health point of view. Furthermore, the natural fluctuations in malaria incidence from year to year, the low cost of the intervention and the challenges of IPTp re-introduction after withdrawal indicate that caution must be exercised in discontinuing IPTp-SP because of recent reductions in transmission. More data will be needed to allow the formulation of more specific guidelines. Please refer to the WHO policy brief for the implementation of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) (82).