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Jack was a reproductive biologist who played a central role in developing antenatal screening as we know it today. He ran a screening laboratory, engaged in research that had a significant impact in the development of the field and was an outstanding teacher of his subject. Jack entered the field of antenatal screening in 1982, when he moved to Women and Infants Hospital in Providence to establish a screening service for neural tube defects and become the laboratory's founding director. In 1987–88, he correctly predicted that maternal serum unconjugated oestriol might be low in Down's syndrome pregnancies because of fetal immaturity. Oestriol is a metabolite from 16-alpha-hydroxy-DHEAS in the fetus that is converted into oestriol in the placenta and then enters the maternal circulation. This idea led to collaboration between Brown University, the Foundation for Blood Research, and the Wolfson Institute of Preventive Medicine. Having identified low levels of oestriol as a screening marker for Down's syndrome, Jack then contributed to incorporating it into the Triple test, which, for a decade or so, became the main screening test for Down's syndrome in antenatal care throughout the world. In this way Jack built on the initial finding that maternal serum alpha-fetoprotein levels were low in pregnancies with Down's syndrome and that hCG levels were high.
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