Perinatal insults (e.g., obstetric complications, substance exposure) are increasing in prevalence and confer risk for psychotic-like experiences in offspring, contributing to a growing public health burden. Perinatal insults often co-occur, creating methodological challenges in understanding their impacts on psychosis-spectrum phenotypes. Data-driven approaches to organizing perinatal insults and testing their longitudinal effects on psychotic-like experiences in youth increases ecological validity and translational utility. Using data from 11,417 youth ages 9-14 across five years of the Adolescent Brain Cognitive Development (ABCD) Study, data-driven dimensions of perinatal insults were derived through exploratory factor analysis of thirty-one perinatal insults. Latent growth modeling tested the effect of perinatal insult dimensions on trajectories (baseline, rate-of-change, year-four severity) of distressing psychotic-like experiences. Six dimensions of perinatal insults were observed (substance exposure, obstetric complications, birth complications, postnatal challenges, parental age, medical needs). Substance exposure (β = 0.42, 95% CI [0.20, 0.63]), obstetric complications (β = 0.34, 95% CI [0.08, 0.61]), and parental age (β = 1.00, 95% CI [0.76, 1.22]) were associated with elevated baseline psychotic-like experiences. Perinatal insult dimensions were not associated with increasing rates-of-change in psychotic-like experiences. Medical needs (β = -0.12, 95% CI [-0.20, -0.05]) and parental age (β = -0.11, 95% CI [-0.18, -0.03]) were associated with steeper declines in psychotic-like experiences. Perinatal insult dimensions remained associated with elevated psychotic-like experiences at year-four. Data-driven dimensions of perinatal insults are associated with stably elevated psychotic-like experience trajectories across early adolescence. Given the role of psychotic-like experiences in later psychopathology and functioning, early identification of at-risk offspring is critical in reducing the public health burden of these exposures.