Adaptive evolution and fixation of drug-resistant Plasmodium falciparum genotypes in pregnancy-associated malaria: 9-year results from the QuEERPAM study

► Plasmodium falciparum mutations conferring drug resistance are widespread. ► We quantified the evolution of drug-resistant haplotypes in Malawi over 9 years. ► Mutations achieved fixation at five loci, but failed to appear at two loci associated with high-level drug-resistance. ► Mutant haplotypes expanded at a rate of 13% over each subsequent parasite generation. ► Longitudinal surveillance of malaria drug resistance can assist predictive modeling.