Bring a large pot of salted water to a rolling boil over high heat. Add the fettuccine and cook until al dente, about 8–10 minutes. Reserve 1 cup of pasta water and drain the rest; set aside.

In a large skillet, melt the butter over medium-low heat. Add minced garlic and sauté for about 1 minute until fragrant.

Stir in the half and half, pumpkin puree, and a pinch of nutmeg. Increase heat slightly and stir continuously until heated through and thickened, about 2–3 minutes.

Mix in the Parmesan cheese, stirring until melted and combined with the pumpkin mixture.

Gradually add reserved pasta water, about half a cup at first, until the desired consistency is achieved.

Add the drained fettuccine to the skillet and toss gently for 1–2 minutes, ensuring each strand is well-coated.

Plate immediately, garnishing with parsley and extra Parmesan cheese.