Review Question - QID 214285

A 28-year-old G1P0 woman presents to her obstetrician for a prenatal visit. She is 30 weeks pregnant. She missed her past few prenatal appointments because she was “stressed at work.” She also states that she has been feeling “under the weather” lately. She thinks this is either due to a cold or allergies to her husband’s cat. The patient also has diagnosed epilepsy. She takes lamotrigine and a daily prenatal vitamin. Her maternal aunt has polycystic kidney disease. The patient’s temperature is 98°F (36.7°C), blood pressure is 160/94 mmHg, and pulse is 70/min. On physical examination, the fundal height is 25 centimeters. A fetal ultrasound shows a reduction in trunk size and limb length with a normal head circumference. Which of the following is the most likely cause of the patient’s presentation?