Bring a large pot filled with water to a boil and cook pasta according to instrucitons on package. Before straining, reserve 1 cup of pasta water.
Meanwhile, in a large saucepan pour in the olive oil and heat over medium heat. Add in the garlic and cook for 1-2 mintues, stirring often. Add in the pumpkin puree, tomato paste and broth and bring to a simmer, stir until combined. Reduce heat to low and add in the cream, balsamic vinegar, nutmeg and salt and pepper, stir and let simmer while pasta cooks.
Strain pasta and transfer to saucpan of pumpkin sauce. Stir in the pasta, adding the reserved water in 1/4 cup increments to thin out the sauce. I used the entire 1 cup of water for the recipe in the pictures above.
Spoon into bowls and sprinkle with parmesan (if using).