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Cook the fettuccine according to package directions. Reserve 1 cup of the cooking liquid in case you want to thin out your sauce.
Heat the butter over medium heat. Add the garlic; saute until soft and fragrant. Add the pumpkin and heavy whipping cream. Simmer until slightly thickened. Add the cheese and stir to combine.
Toss the pasta in the sauce and thin as needed using the reserved cooking liquid. Top with additional Parm and season to taste (I used at least one teaspoon coarse sea salt). Serve immediately. ♡