We thank Dr Serati et al for their letter to the editor about our paper. 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. 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. 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. 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.