In 1982, Mizejewski demonstrated the feasibility of measuring AFP in dried blood, albeit in newborns.15 In the early 1990s, we implemented a second trimester dried blood free beta hCG/AFP assay16 and later implemented a first trimester Down syndrome screening program with a dual-analyte dried blood spot free Beta hCG/PAPP-A assay.7 This evidence concerns the gene PAPPA and Down syndrome.