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Published:August 10, 2015DOI:https://doi.org/10.1016/j.ajog.2015.08.005
      We thank Dr Serati et al for their letter to the editor about our paper.
      • Mei-Dan E.
      • Ray J.G.
      • Vigod S.N.
      Perinatal outcomes among women with bipolar disorder: a population-based cohort study.
      They posit that our observed higher risk of gestational diabetes mellitus and large-for-gestational birthweight might be due to atypical antipsychotic medication use in pregnancy. While not evaluated in the current study, we did an evaluation within another population-based study of 1021 antipsychotic-exposed pregnancies that were matched by high-dimensional propensity score to 1021 unexposed pregnancies.
      • Vigod S.N.
      • Gomes T.
      • Wilton A.S.
      • Taylor V.H.
      • Ray J.G.
      Antipsychotic drug use in pregnancy: high dimensional, propensity matched, population based cohort study.
      Therein, although antipsychotic users were at higher than general population risk for the aforementioned perinatal outcomes, there were no differences between antipsychotic users and matched control subjects.
      • Vigod S.N.
      • Gomes T.
      • Wilton A.S.
      • Taylor V.H.
      • Ray J.G.
      Antipsychotic drug use in pregnancy: high dimensional, propensity matched, population based cohort study.
      In another recent population-based study among 874 pregnant women with bipolar disorder, those with bipolar disorder were at higher risk for various adverse perinatal outcomes than those without bipolar disorder, but there were no differences of treated vs untreated women with bipolar disorder on these outcomes.
      • Boden R.
      • Lundgren M.
      • Brandt L.
      • Reutfors J.
      • Andersen M.
      • Kieler H.
      Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study.
      Taken together, we believe that factors other than medications, such as prepregnancy medical health and social and lifestyle factors, better explain the higher risk for adverse perinatal outcomes in this population. As the authors of the letter correctly point out, the early care of women with bipolar disorder is of great importance, whether pregnant or not.

      References

        • Mei-Dan E.
        • Ray J.G.
        • Vigod S.N.
        Perinatal outcomes among women with bipolar disorder: a population-based cohort study.
        Am J Obstet Gynecol. 2015; 212: 367.e361-367.e368
        • Vigod S.N.
        • Gomes T.
        • Wilton A.S.
        • Taylor V.H.
        • Ray J.G.
        Antipsychotic drug use in pregnancy: high dimensional, propensity matched, population based cohort study.
        BMJ. 2015; 350: h2298
        • Boden R.
        • Lundgren M.
        • Brandt L.
        • Reutfors J.
        • Andersen M.
        • Kieler H.
        Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study.
        BMJ. 2012; 345: e7085

      Linked Article

      • Factors that affect duration of untreated illness in pregnant women with bipolar disorder
        American Journal of Obstetrics & GynecologyVol. 213Issue 6
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          We read with interest the paper by Mei-Dan et al1 who conducted a study about perinatal outcomes among women who are affected by bipolar disorder. The authors found that mothers with bipolar disorder have an increased risk of preterm birth and severe large-for-gestational-age babies. This latter finding may be due to treatment with atypical antipsychotics (eg, olanzapine), which are associated to higher risk of diabetes mellitus and increased weight of newborn infants.2
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