Down syndrome (Trisomy 21) Quiz: Ace Your Exams

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A 39-year-old woman, gravida 1, para 0, comes to the office for the evaluation of abnormal laboratory results. The patient is at 17 weeks gestation according to her last menstrual period. She used to drink 1 glass of wine on weekends during the first trimester, as she was unaware of the pregnancy. Past medical history is unremarkable. She regularly takes prenatal vitamins, and her immunizations are up to date. Results of the quadruple test are shown:  
 
 Laboratory value  Result 
 Maternal serum alpha fetoprotein  Low 
 Unconjugated estriol  Low 
 β-HCG  High 
 Inhibin A  High 

The fetus is at greatest risk of developing which of the following?

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