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Purpose: To examine the risk of perinatal mental illness, including new-onset disorders and recurrent or ongoing use of mental health care, comparing women with physical, sensory, intellectual/developmental, and multiple disabilities to those without a disability. Methods: From all women aged 15–49 years with a singleton birth in Ontario, Canada (2003–2018), those with physical (n = 144,972), sensory (n = 45,249), intellectual/developmental (n = 2,227), and ≥ 2 of these disabilities ("multiple disabilities"; n = 8,883), were compared to 1,601,363 without a disability on risk of healthcare system contact for mental illness from conception to 365 days postpartum. The cohort was stratified into: (1) no pre-pregnancy mental illness (to identify new-onset illness), (2) distal mental illness (> 2 years pre-pregnancy, to identify recurrent illness), and (3) recent mental illness (0–2 years pre-pregnancy, to identify ongoing contact). Modified Poisson regression generated relative risks (aRR), adjusted for age, parity, income quintile, and rural residence. Results: About 14.7, 26.5, and 56.6% of women with no disabilities had new-onset, recurrent, and ongoing contact for mental illness, respectively, perinatally. Risks were elevated across disability groups for new-onset (physical: aRR 1.18, 95% CI 1.16–1.20; sensory: 1.11, 1.08–1.15; intellectual/developmental: 1.38, 1.17–1.62; multiple: 1.24, 1.15–1.33), recurrent (physical: 1.10, 1.08–1.12; sensory 1.06, 1.02–1.09; intellectual/developmental: 1.24, 1.11–1.37; multiple: 1.16, 1.09–1.23), and ongoing contact (physical: 1.09, 1.08–1.10; sensory: 1.08, 1.06–1.10; intellectual/developmental: 1.31, 1.26–1.37; multiple: 1.20, 1.16–1.23). Conclusion: The heightened use of new, recurrent, and ongoing mental health care across disability groups in the perinatal period suggests that adapted screening and intervention approaches are critical to optimize perinatal mental health in this population. [ABSTRACT FROM AUTHOR]