POLICY AND PREVENTION Universal Prevention is Associated with Lower Prevalence of Fetal Alcohol Spectrum Disorders

Prevalence of fetal alcohol spectrum disorders (FASDs) is remarkably high in several provinces of South Africa; yet population-level knowledge of the harms of maternal drinking remains low. In two heavily affected areas, we assessed effective-ness of interventions to heighten awareness of these harms and to alter social norms about drinking in pregnancy. Methods: FASD prevalence, maternal knowledge and drinking behaviours were investigated in two Northern Cape Province towns, before and after interventions which included highlighting FASD using local media and health promotion talks at health facilities. Independently, two dysmorphologists and a neuropsychometrist examined children at 9 and 18 months. Results: Pre-intervention maternal knowl-edge of alcohol harms was low and FASD prevalence 8.9 % (72/809). Interventions reached high coverage and knowledge levels increased substantially. FASD prevalence was 5.7 % post-intervention (43/751; P = 0.02); 0.73 lower odds, controlling for maternal age and ethnicity (95 % confidence interval = 0.58–0.90). No change was detected in more severe FASD forms, but in the whole population, median dysmorphology scores reduced from 4 [inter-quartile range (IQR) = 2–7] to 3 (IQR = 1–6; P = 0.002). Conclusion: This, the first prevention study using FASD outcomes, suggests that universal prevention might reduc