<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 36-year-old primigravid woman at 22 weeks gestation comes to the physician for a routine prenatal visit. Her previous prenatal visits showed no abnormalities. She has hyperthyroidism treated with methimazole. She previously smoked one pack of cigarettes daily for 15 years but quit 6 years ago. She reports gaining weight after quitting smoking, after which she developed her own weight loss program. She is 168 cm 5 ft 6 in tall and weighs 51.2 kg 112.9 lb; BMI is 18.1 kgm2. Her temperature is 37C 98.5F, pulse is 88min, and blood pressure is 11572 mm Hg. Pelvic examination shows no abnormalities. The fundus is palpated between the symphysis and the umbilicus. Ultrasound shows a fetal head at the 20th percentile and the abdomen at the 9th percentile. Fetal birth weight is estimated at the 9th percentile and a decreased amniotic fluid index is noted. The maternal quadruple screening test was normal. Thyroid-stimulating hormone is 0.4 mIUmL, triiodothyronine T3 is 180 ngdL, and thyroxine T4 is 10 μgdL. Which of the following is the strongest predisposing factor for the ultrasound findings in this patient?? A: Maternal malnutrition, B: Advanced maternal age, C: Fetal aneuploidy, D: History of tobacco use, E: Maternal hyperthyroidismn,  <response>: This is a question about identifying the strongest predisposing factor for abnormal fetal growth based on the clinical history and examination findings in a pregnant woman. The key findings are:- 36-year-old primigravid woman at 22 weeks gestation - History of hyperthyroidism on methimazole- Former smoker 1 pack per day for 15 years, quit 6 years ago- Low BMI of 18.1 kgm2 suggestive of malnutrition - Ultrasound shows small fetal head and abdomen, estimated low fetal birth weight, and low amniotic fluid - Normal maternal screening tests- Well-controlled hyperthyroidism based on thyroid function testsThe choices include maternal malnutrition, advanced maternal age, fetal aneuploidy, tobacco use history, and maternal hyperthyroidism. Of these, the strongest predisposing factor is likely maternal malnutrition given the very low BMI. Advanced maternal age could play a role but is less likely. Fetal aneuploidy is not supported. Tobacco use history is remote. Maternal hyperthyroidism is well-controlled on methimazole.A: Maternal malnutrition 