However, the uptake of at least two doses of SP observed in the present study was lower than 35% reported previously in the same study area [28], reflecting the inconsistency of drug supply at the time of survey in the given area. collected for diagnosis of malaria by microscopy and rapid diagnostic tests (RDTs). Gestational age was estimated based on last menstrual period or Ballard score. Infant birth weights were recorded within 24 hours of delivery. == Results == Of 431 participants, 167 (38.75%), 134 (31.09%), 104 (24.23%), and 26 (6.03%) reported taking none, one, two, and three doses of SP during pregnancy, respectively. The uptake of three doses of IPTp-SP among delivering women at Geita hospital and Katoro health centre was 9.06% and 1.2%, respectively. The overall prevalence of malaria in pregnancy by RDT, peripheral and placental smears was 19.5%, 29.7% and 37.6% respectively. The prevalence of placental parasitaemia was higher for women who delivered at Katoro Health Centre (41.57%) than those N6,N6-Dimethyladenosine who delivered at Geita hospital (35.09%). The uptake of three doses of SP was associated with reduced odds of having placental malaria (adjusted odds ratio (AOR) = 0.31,p =0.039) compared to < three doses. Women with placental parasitaemia were five times more likely to have delivered pre-term (AOR = 4.67,p =0.002) and had lower mean birth weight infants than their uninfected counterparts (mean difference = 82 g,p =0.039). == Conclusions == The uptake of three doses of IPTp-SP is low in the present study area. Placental parasitaemia is prevalent and is associated with adverse birth outcomes. N6,N6-Dimethyladenosine Receipt of three doses of IPTp-SP reduced the odds of placental parasitaemia. Thus, increased efforts towards scale-up and continuous evaluation of IPTp-SP efficacy is recommended. Keywords:Pregnancy, Intermittent preventive treatment, Sulphadoxine-pyrimethamine placental malaria, Pre-term delivery, Low birth weight, Tanzania == Background == Of the 125 million pregnant women who are at risk ofPlasmodium falciparuminfection each year, 30 million are from SSA [1].Plasmodium falciparummalaria infection during pregnancy presents significant risks for the pregnant woman, the developing foetus and the new-born infant. The negative consequences associated with malaria in pregnancy include: severe malaria, severe anaemia, pre-term delivery, maternal death, and placental malaria [24]. Placental malaria is linked to intra-uterine growth restriction, stillbirth, and delivery of low birth weight (LBW) infants [5,6]. Pre-term delivery and LBW are the risk factors for neonatal and infant deaths [7]. In Africa where malaria is endemic, malaria-causing LBW kills between 62,000 and 363,000 new-borns every year [8,9]. In Tanzania, 93% of the population is at risk of malaria infection.Plasmodium falciparummalaria is responsible for up to 125,000 deaths in Tanzania, of which, 70,000-80,000 deaths occur in children who are under five years old [10]. The disease accounts for at least one fifth of all maternal deaths N6,N6-Dimethyladenosine in Tanzania [11]. To prevent the effects ofP. falciparummalaria during pregnancy, the World Health Organization (WHO) currently recommends intermittent preventive treatment of malaria in pregnancy (IPTp) using sulphadoxine-pyrimethamine (SP) at each scheduled antenatal care (ANC) visit after the first trimester [12]. In SSA, the effectiveness of IPTp-SP in preventing malaria-related adverse pregnancy outcomes is well established [1315]. Despite the widespread adoption of IPTp in malaria-endemic countries in Africa, the coverage of recommended doses of IPTp-SP remains elusive [16]. In 2012, the median coverage of CD93 at least one, two and three doses N6,N6-Dimethyladenosine of SP during pregnancy in SSA was 64% (range 25-85%), 38% (range 10-64%), and 23% (range 2-44%), respectively [17]. In Tanzania, the coverage of at least one and two doses as per Tanzania HIV/AIDS Malaria Indictor Survey 2011/12 was 60% and 32%, respectively [18]. In addition, the widespread SP resistance caused byP. falciparumdihydrofolate reductase/dihydropteroate synthase(pfdhfr/pfdhps) quintuple or sextuple mutations [19,20] is likely to affect the efficacy of SP in East Africa, including Tanzania. However, a recent systematic review and meta-analysis showed beneficial effects of three or more doses of SP during pregnancy in prevention of malaria-related adverse outcomes, even in areas with moderate to high SP resistance [21]. The new IPTp regimen has recently been implemented in Tanzania; thus the level of uptake and its association with pregnancy outcomes remains unknown in various regions of the country. The purpose of the present study was to determine the uptake of SP among pregnant women based on the revised recommendations, and to evaluate.