Bring a large pot of salted water to a boil. Add fettuccine and cook until al dente, about 8-10 minutes. Reserve 1/2 cup of pasta water before draining.

In a skillet over medium heat, melt butter and sauté minced garlic until fragrant, about 1-2 minutes. Avoid browning.

Stir in pumpkin puree and heavy cream, and add nutmeg and cinnamon. Heat through for 3-5 minutes until smooth.

Whisk in Parmesan cheese until melted. Adjust thickness with reserved pasta water if needed.

Toss cooked fettuccine in the sauce, season with salt and pepper to taste.

Serve with parsley or sage garnish and sprinkle toasted pumpkin seeds on top if desired.