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Over high heat, bring a stockpot of water to boil. Add a teaspoon of salt to the water, then add the fettuccine. Cook the fettuccine al dente according to the directions on the box.
Meanwhile, melt butter over medium-low heat. Stir in garlic and cook for about 1 minute, careful not to burn. Stir in half & half, Parmesan cheese, pumpkin puree, and nutmeg. Stir until sauce is heated through and cheese is melted. Stir in the pasta water, a little at a time, until sauce is desired consistency. Use more water for a thinner sauce.
Add pasta and cook over medium-high heat until sauce is smooth and pasta is well coated, about 1 – 2 minutes.
Serve with chopped fresh parsley and freshly grated Parmesan cheese.