Bring a large pot of salted water to a rolling boil. Add the gnocchi and cook until they float, approximately 2-3 minutes. Drain and set aside.

In a skillet, heat 1 tablespoon of olive oil over medium-high heat. Add the Italian sausage, breaking it into crumbles. Cook until browned, about 5-7 minutes. Remove from skillet.

In the same skillet, reduce heat to medium and add minced garlic. Sauté for 1 minute until fragrant. Mix well.

Lower heat to medium-low, add pumpkin puree and heavy cream, stirring until bubbling, about 2-3 minutes. Add Parmesan cheese, nutmeg, salt, and pepper, stirring until smooth.

Add cooked gnocchi and fresh spinach to the sauce, toss gently until coated, about 2 minutes.

Return sausage to the skillet and stir until heated through, about 2 minutes.

Serve immediately, garnished with fresh parsley or basil if desired.