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Background: Offspring of mothers with T2D are at increased risk of obesity and diabetes. In the MiTy trial [pregnant T2D randomized to metformin vs. placebo], infants exposed to metformin were lighter, had lower fat-mass and risk of large-for-gestational-age, but at higher risk of small-for-gestational-age. There are questions on the long-term effects of in-utero exposure to metformin on offspring of women with T2D. Aim: To examine adiposity in children of women with T2D, with and without exposure to metformin, up to 24 months. Methods: We included infants of women who participated in MiTy. Anthropometric measurements were made at 3, 6, 12, 18 and 24 months of age. At 24 months, t-tests and linear regression were used to estimate differences in BMI z-score and sum of skinfolds by metformin group, adjusted for confounders. Comparisons over time used longitudinal models, with fractional polynomials for growth trajectories. Results: Of the 465 eligible children from MiTy, 283 (60.8%) participated in MiTy Kids. At 24 months, there was no difference in BMI z-score (0·84±1·52 in metformin vs. 0·91±1·38 in placebo (p=0.72)) or sum of skinfolds (23·0±5·2 in metformin vs. 23·8±5·3 in placebo (p=0.31)) between groups. There was no difference in BMI trajectory by treatment overall but in males, treatment had significantly different trajectories (p=0.048) ; the metformin BMI was higher from 8 to 24 months. At 24 months, reduced sleep time (p=0.0125) and increased screen time (p=0.0549) were associated with increased BMI z-score. Offspring of women with T2D were approximately 1 SD heavier than the WHO reference population. Conclusion: Offspring of women with T2D with and without exposure to metformin in-utero had similar anthropometrics overall. In males, metformin led to higher BMI growth trajectory between 8 and 24 months. Future follow-up is needed to see if these findings continue. Disclosure D.Feig: Advisory Panel; Novo Nordisk, Research Support; Apotex. A.Armson: None. J.F.R.Barrett: None. L.E.Donovan: Other Relationship; Dexcom, Inc., Inner Analytics, Medtronic, Tandem Diabetes Care, Inc. P.Karanicolas: Research Support; Baxter. G.Klein: None. S.Tobin: None. K.Mangoff: None. G.Tomlinson: None. J.Hamilton: Advisory Panel; Novo Nordisk Canada Inc., Research Support; Mead Johnson & Company, LLC. J.Sanchez: None. K.Murphy: None. E.Asztalos: None. B.Zinman: Advisory Panel; Abbott Diabetes, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Canada Inc., Sanofi K.K. D.Simmons: Other Relationship; Elsevier, Research Support; Abbott, Hitachi, Ltd., Novo Nordisk, Speaker's Bureau; Sanofi. A.Haqq: None. I.G.Fantus: None. L.Lipscombe: n/a. Funding Canadian Health Institute for Research

Background: In the MiTy trial [pregnant T2D randomized to metformin vs. placebo], infants exposed to metformin in-utero had a lower risk of large-for-gestational-age (LGA) but were at higher risk of small-for-gestational-age (SGA) . To date, there are limited data on the effect of in-utero exposure to metformin on infant/child growth in T2D, according to the intrauterine growth status. The MiTy Kids study followed the offspring of MiTy participants to 24 months of age to examine the effect of metformin exposure in-utero on child growth. Aim: Examine the weight and body mass index (BMI) trajectories of children of women with T2D, according to the intrauterine growth status [appropriate for gestational age (AGA) , LGA, and SGA] and metformin exposure. Methods: The study population included offspring of MiTy trial participants. Height and weight measurements were collected at 3, 6, 12, 18 and 24 months of age. Analysis of data was conducted using a fractional polynomial linear mixed effects approach to compare growth trajectories. Results: Of the 283 children who participated in MiTy Kids (46.3% female) , 194 children were AGA at birth (90 metformin and 1placebo) , 65 were LGA (29 metformin and 36 placebo) , and 24 were SGA (16 metformin and 8 placebo) . In children born AGA, both sexes in the metformin arm had a lower weight gain trajectory than those in the placebo group (p=0.008) . Treatment and sex did not have an effect on the growth trajectories of children born LGA. In SGA children, in both sexes, SGA children in the metformin group had a lower weight gain trajectory (p= Conclusion: Metformin exposure in-utero was associated with lower weight gain trajectories and BMI trajectories in children of both sexes born SGA and lower weight gain trajectory in AGA children. Further follow-up will determine subsequent growth in these children. Disclosure J. Sanchez: None. J. Hamilton: Advisory Panel; Novo Nordisk Canada Inc. Research Support; Mead Johnson & Company, LLC. G. Tomlinson: None. E. Asztalos: None. K. Murphy: None. B. Zinman: Advisory Panel; Abbott Diabetes, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Canada Inc., Sanofi K.K. D. Simmons: Research Support; Abbott, Hitachi, Ltd., Novo Nordisk. Speaker's Bureau; Sanofi. Other Relationship; Elsevier. A. Haqq: None. I.G. Fantus: None. A. Armson: None. J.F.R. Barrett: None. L.E. Donovan: Other Relationship; Dexcom, Inc., Inner Analytics, Medtronic, Tandem Diabetes Care, Inc. P. Karanicolas: Research Support; Baxter. Y. Jiang: None. S. Tobin: None. K. Mangoff: None. G. Klein: None. D. Feig: Advisory Panel; Novo Nordisk. Research Support; Apotex. Funding Canadian Institutes of Health Research