Introduction: Nonadherence to antimalarial for prophylactic use during pregnancy, can lead to undesirable effect such as treatment failure and adverse consequences of severe malaria to pregnant women and their unborn babies. This work was conducted to assess the level and patterns of adherence to repeated dose regimens of dihydroartemisinin-piperaquine for intermittent preventive treatment in pregnant women. Methods: A prospective intervention study was carried out for twelve months in Federal Medical Centre Keffi, Nigeria. The participants were HIV- negative pregnant women who consented and received three repeated regimens of dihydroartemisinin-piperaquine for intermittent preventive therapy in pregnancy during clinical study. The subjects received first, second and third regimens at intervals of not less than four (4) weeks. The Four-item Morisky's Medication Adherence Scale (MMAS-4) was adopted and used to assess self-reported medication adherence. Respondents were considered highly adherent to the regimen if they responded negatively to all four questions. Results: Among 115 subjects who received three regimens, High, moderate and low adherences to dihydroartemisinin-piperaquine were 82(71.3%), 30(26.1%) and 3 (2.6%) respectively. The assessment revealed that forgetfulness (20.9%) and side effects (2.6%) were the most common factors contributing to nonadherence among the subjects. The level of adherence indicated that more than 60% of participants received second and third scheduled regimens of the study agent. However, the distribution of adherence among the gravidity showed no significant (P=0.201) difference. Conclusion: Majority of pregnant women who completed three full courses of dihydroartemisinin-piperaquine were scored as highly adherent. Forgetfulness was the strongest factor associated with nonadherence. Thus, nonadherence should be seen as one of the potential barrier that must be overcome for intermittent preventive therapy with dihydroartemisinin-piperaquine. Similarly, the success of this regimen will require proper counselling on medication use.